Q&A: Determining usefulness of inpatient sleep tests for sleep-disordered breathing

Key takeaways:

• A grant winner plans to assess the usefulness of inpatient sleep tests.
• This research will shed light on which patients should receive an inpatient sleep test.

Individuals with suspected sleep-disordered breathing must undergo sleep testing to be formally diagnosed and treated. However, the benefits of inpatient vs. outpatient sleep assessments are unclear.

With help from a grant from the American College of Chest Physicians (CHEST) and the American Academy of Sleep Medicine Foundation, Tetyana Kendzerska, MD, PhD, winner of the grant and associate professor in the department of medicine at the University of Ottawa, and Marcus Povitz, MD, co-principal investigator and clinical associate professor at University of Calgary, hope to bring some clarity to this debate through a retrospective analysis of health administrative databases.

As Healio previously reported, the Research Grant in Sleep Medicine is given to a researcher with a topic that will push the sleep medicine field forward and lead to better patient outcomes.

Healio spoke with Kendzerska to learn more about her research topic, the motivation behind wanting to explore this topic and benefits that will emerge from this research.

Healio: What are the benefits of sleep testing?

Kendzerska: Sleep-disordered breathing (SDB) is the most prevalent sleep disorder characterized by abnormal breathing during sleep that causes disturbed sleep and low oxygen in sleep. Untreated SDB is associated with poor quality of sleep, affected daytime functioning, adverse long-term health outcomes, such as heart disease, and an increased burden on the health care system. Sleep testing is essential in SDB management and is required to identify/diagnose SDB and to guide a treatment decision. A clinical assessment alone is not very accurate at diagnosing SDB or describing its severity.

Healio: How common is usage of inpatient sleep tests, as well as outpatient sleep tests?

Kendzerska: Usually, sleep tests are done on non-hospitalized individuals (outpatient test) for practical and financial reasons. The usefulness of sleep testing in adults admitted to the hospital (inpatient test) is unclear. Inpatient sleep tests are much less frequent than outpatient tests; they are labor-intensive and expensive yet might improve survival and reduce readmissions due to early treatment initiation.

Delaying a test until after a person has been discharged allows for stabilizing underlying medical conditions and improving sleep pattern. However, some individuals may face barriers in accessing a sleep test as outpatients. There is no consensus on which patients should undergo inpatient sleep tests. Information on prevalence and associated costs is lacking.

Healio: What are some of the known weaknesses of inpatient and outpatient sleep tests?

Kendzerska: There are drawbacks to both inpatient and outpatient sleep tests. One being that they are logistically complicated, labor-intensive and high cost, given the medical complexity of the hospitalized individuals, and the other being that they are affected by the challenges of accessing appropriate care due to long wait times and frequent failures of communication.

Healio: How will your research assess these differences?

Kendzerska: Our research will thoroughly review cost, hospital visits, obstructive sleep apnea treatment initiation and overall outcomes to understand the usefulness of inpatient sleep tests and to identify individuals who could benefit the most.

Healio: What inspired you to want to research inpatient sleep tests?

Kendzerska: Our general aim as sleep medicine clinicians and researchers is to ensure that individuals with SDB are diagnosed and treated as early as possible to prevent short- and long-term consequences of SDB, a highly prevalent and, at the same time, highly under-recognized and under-diagnosed condition.

The community affected by underdiagnosis is likely to be socially and materially disadvantaged. Patients who are less health literate may be more likely to misattribute their symptoms and delay diagnosis. There may also be cultural and language differences that prevent them from receiving an accurate and prompt diagnosis.

Healio: What do you hope to achieve with your research? How will your research impact patients diagnosed with sleep-disordered breathing and those not yet diagnosed?

Kendzerska: To address the current information gap about the usefulness of inpatient tests, we will use data from health care visits to assess how many individuals who underwent inpatient sleep tests were seen by a sleep physician and initiated treatment compared with those who underwent outpatient tests. We will also describe and compare individuals who underwent inpatient vs. outpatient sleep tests. Finally, we will compare health system costs, the number of outpatient and inpatient visits, and all-cause death during the first year in adults who underwent an inpatient vs. outpatient test.

Our findings will help physicians decide who should undergo an inpatient sleep test and provide a rationale to allocate additional resources to hospitals to support individuals who cannot access sleep tests otherwise. Additionally, our findings will contribute to the development of guidelines for inpatient sleep studies.

Reference:

• The American College of Chest Physicians and the American Academy of Sleep Medicine Foundation advance sleep research in 2024 through partnership grant. https://www.chestnet.org/Newsroom/Press-Releases/2024/01/CHEST-and-AASM-Foundation-Partnership-Grant. Published Jan. 17, 2024. Accessed Jan. 18, 2024.