Evolution of Sleep Apnea Testing

Summary

  • Since 2007, increasing evidence support for Out of Center Sleep Testing (OCST) or Home Sleep Testing (HST) technology has led to the development of clinical guidelines that recommended embracement of OCST.
  • It was found that the treatment outcomes and compliance of patients diagnosed with sleep apnea by OCST were not substandard to those diagnosed by in-laboratory polysomnography.
  • The Portable-monitor Testing (PT) is increasingly being used in the ambulatory diagnosis and management of patients with Obstructive Sleep Apnea (OSA).
  • Significant financial savings were reported by a cost analysis based on the HST model when compared to the PSG model.
  • While appropriate patient selection and adequate management is the prime concern, improved, and affordable access to sleep care has led to better patient outcomes.
  • ISD Health Solutions is an HST provider in the Caribbean who provides multi-night, FDA-approved, and affordable service in the comfort of your home.

While it may sound lousy to sleep more, lack of sleep has tremendous health issues. Rechtschaffen et al. conducted research on the implications of sleep deprivation on rats’ health and found that sleep-deprived rats died within two to three weeks [1].

There has been continual research on the patterns, mechanisms, and implications of sleep apnea. At the same time, the correct diagnosis of sleep apnea is very important for the disposal of the right treatment modalities for the management of the condition and its subsequent sequelae.

From spending the night at a clinic to having access to a disposable home sleep test, the diagnosis and testing of sleep apnea have evolved significantly over time. Herein, we are going to discuss how sleep apnea testing has eventually gotten more comfortable and flexible.

Increased Supporting Evidence and Patient Compliance

Out of Center Sleep Testing (OCST) or Home Sleep Testing (HST) technology has been introduced for quite some time now. From 1994 to 2003, The American Academy of Sleep Medicine (AASM) and its precursor’s Practice parameters claimed that there had been insufficient evidence supporting its use in the clinical practice [2, 3, 4]. Adequate evidence was achieved by the end of 2007, which lead to the development of clinical guidelines that recommended the embracement of OCST.

Studies have shown that OCST can be efficiently employed with appropriate selection and management of patients. Kuna et al. reported that the treatment outcomes and compliance of patients diagnosed with sleep apnea by OCST and managed with Autotitrating Positive Airway Pressure (APAP) were in no way substandard to patients diagnosed by in-laboratory polysomnography and managed with CPAP through in-lab titration [5].

Technological Advancement

One of the key factors considered to have contributed to HST’s acceptance is the technological advancements made during the last few decades. One such advancement is the Portable-monitor Testing (PT) which is increasingly being used in the ambulatory diagnosis and management of patients with Obstructive Sleep Apnea (OSA) [6].

While technology has led to reduced accessibility and affordability of medicine, HST evolution has predominantly done vice versa. Technological development has allowed enormously sophisticated monitoring to be feasibly accessible at home. For example, the ECG algorithms analysis has paved the way for evaluation of sleep staging without EEG monitoring.

Cost-Effectiveness

Significant financial savings were reported by a cost analysis based on the HST model when compared to the PSG model. Patient compliance has also been found to improve with improved convenience and affordability. Shifting of emphasis to less expensive and less time-consuming diagnosis and therapy has become a trademark of the paradigm shift in OSA [7]

At-Home Sleep Testing in the Caribbean

Affordable access to sleep care has led to better patient outcomes. HST allows for longitudinal studies for adequate and continuous care. ISD Health Solutions is an HST provider in the Caribbean that provides multi-night, FDA-approved, and affordable service at the comfort of your home.

References:

  1. Shepard JW Jr, Buysse DJ, Chesson AL Jr, et al. History of the development of sleep medicine in the United States. J Clin Sleep Med. 2005;1(1):61-82. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2413168/
  2. American Sleep Disorders Association Report. Standards of Practice Committee. Practice parameters for the use of portable recording in the assessment of obstructive sleep apnea. Sleep. 1994;17:372-7.
  3. American Sleep Disorders Association Report. Standards of Practice Committee. Practice parameters for the indications for polysomnography and related procedures. Sleep. 1997;20:406-22.
  4. Chesson AL, Berry R, Pack A. Practice parameters for the use of portable monitoring devices in the investigation of suspected obstructive sleep apnea in adults. A joint project sponsored by the American Academy of Sleep Medicine, the American Thoracic Society, and the American College of Chest Physicians. Sleep. 2003;26:907-13.
  5. Kuna ST, Gurubhagavatula I, Maislin G, et al. Noninferiority of functional outcome in ambulatory management of obstructive sleep apnea. Am J Respir Crit Care Med. 2011;183:1238–1244.
  6. Berry RB, Hill G, Thompson L, McLaurin V. Portable monitoring and autotitration versus polysomnography for the diagnosis and treatment of sleep apnea. Sleep. 2008;31(10):1423-1431.
  7. Rosen CL, Auckley D, Benca R, et al. A multisite randomized trial of portable sleep studies and positive airway pressure autotitration versus laboratory-based polysomnography for the diagnosis and treatment of obstructive sleep apnea: The HomePAP Study. Sleep. 2012;35:757-767.
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