Sleep Disorders

Home Sleep Apnea Testing

An enterprise-wide home sleep apnea testing (HSAT) program was launched in 2013. HSAT is an integral component of the Obstructive Sleep Apnea (OSA) Care Path that provides the framework for implementing a standardized, cost-effective approach for identifying and setting the stage to treat OSA. HSAT, a confirmatory test for patients with high pretest probability of moderate-to-severe OSA, has experienced consistent volume growth: from 2013 to 2017, there was an approximate 7-fold increase in HSAT volume, while in-laboratory testing (i.e., polysomnogram, PAP, and split studies) has remained stable.

All sleep test orders are reviewed by a board-certified sleep specialist to help determine the most clinically appropriate and cost-effective sleep testing for the patient. Approximately 10,500 sleep study orders were reviewed in 2017; 75% were for in-laboratory sleep tests and approximately 25% were for HSAT studies. After review, 15.3% of orders were recommended to be changed from in-lab sleep testing to HSAT, and 10.4% were recommended to be changed from HSAT to in-lab sleep testing, resulting in a net change of 4.9% in favor of HSAT, the more cost-effective alternative.

The HSAT failure rate ranged from 3.2% to 10.4% over the past 12 months. Of the failed studies (defined as being of insufficient quality or duration to lead to a diagnosis), approximately two-thirds were due to patient’s inappropriate use of the device and one-third were due to a machine malfunction. Reduction in the HSAT failure rate is likely attributable to a dedicated sleep technologist who prepares equipment, downloads recorded data, and interacts with patients regarding their test. Other changes have included enhanced patient educational materials with an improved, colorful, step-by-step patient guide on how to apply sensors and making the nasal/oral sensor easier to use by combining 2 sensors into 1. As shown in the graph, the failure rate declined regardless of whether devices were mailed or picked up by the patient.

Percentage of Home Sleep Apnea Testing Failures for Devices Deployed in Ohio