Outcomes for patients with suspected obstructive sleep apnea (OSA) were not inferior when managed with data from limited-channel sleep testing versus full laboratory-based polysomnography (PSG). The findings, published in Annals of Internal Medicine, suggest that data for informing OSA patient management can be obtained at home.
Demand for diagnostic sleep services has grown substantially due to the prevalence of OSA. Considered the gold standard for OSA evaluation, PSG can be labor-intensive, time-consuming, and costly. In response, there has been a push for the adoption of limited-channel sleep studies, which record fewer physiologic signals than during PSG and are increasingly conducted at home, to diagnose suspected OSA. While previous studies have found that there are similar patient outcomes with limited-channel testing versus PSG, it is unclear whether they should be adopted in routine practice for a broad range of patients being evaluated for OSA.
In a randomized controlled trial, researchers separated patients into one of three groups, which determined the level of sleep study information to be disclosed to treating physicians: full polysomnographic data, cardiorespiratory data only, or oximetry and heart rate data only. Sleep study reports and data corresponding to the randomized groups were distributed to treating physicians to guide diagnosis and management. After review, a similar proportion of patients were diagnosed with moderate to severe OSA and received similar treatment recommendations in all groups.
Authors of an accompanying editorial say that these results are welcome news to health providers and other stakeholders interested in delivering cost-effective care options, like home sleep testing (HST). The lack of infrastructure required for HST allows for reduced wait times for testing, and the ability to expand access to underserved groups, such as rural populations. Professional medical societies will need to work with payers and other stakeholders to ensure an economically-sustainable strategy of replacing in-laboratory polysomnography with HST in order to provide high-value-care for patients with this common disease.