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HOME SLEEP APNEA TESTING: ARE WE DOING IT RIGHT IN PRIMARY CARE?

      TOPIC: Sleep Disorders
      TYPE: Original Investigations
      PURPOSE: Home sleep apnea testing (HSAT) has been in use for years as an alternative to polysomnography for diagnosing obstructive sleep apnea. Primary care providers order the vast majority of HSAT. Major society guidelines recommend against HSAT in high-risk patients and people with possible false positive or negative results. Despite these recommendations, many primary care providers order HSAT in persons who might have initially qualified for polysomnography. Here in our study, we analyze the HSAT orders from two primary care clinics over three years.
      METHODS: Institutional review board (IRB) approval for the study was obtained from the respective IRB board. Data were analyzed using Microsoft excel. Severe Congestive heart failure, severe chronic obstructive pulmonary disease, Opioid dependency, severe depression, history of stroke, and oxygen dependency were selected as conditions that warranted direct polysomnography without HSAT.
      RESULTS: A total of 297 HSATs were ordered between January 2018 and December 2020. This comprised 159 female patients and 138 male patients; the median age was 54. Out of this, 44% (130) had at least one condition among the selected group of conditions. Among people who had HSAT despite disqualifying condition, 78% of people had positive HSAT (Vs. 65 % in the group without disqualifying condition). About 86% of the positive HSAT were followed by a laboratory-based sleep study, which confirmed the result in all the cases.
      CONCLUSIONS: HSAT is being ordered extensively in primary care clinics, but the exclusion criteria are not strictly followed. This is leading to an unnecessary burden on health care and patients.
      CLINICAL IMPLICATIONS: Increased awareness among primary care clinicians is needed to avoid unnecessary HSAT.
      DISCLOSURES: No relevant relationships by Girendra Hoskere, source=Web Response
      No relevant relationships by Rasheed Musa, source=Web Response
      No relevant relationships by Nizar Obeidat, source=Web Response
      No relevant relationships by Akesh Thomas, source=Web Response