Making the Most of Simplified Sleep Apnea Testing
Authors: Lucas M. Donovan, Sanjay R. Patel
Journal: Annals of Internal Medicine (2017)

Editorials7 March 2017Making the Most of Simplified Sleep Apnea TestingLucas M. Donovan, MD and Sanjay R. Patel, MD, MSLucas M. Donovan, MDFrom University of Washington, Seattle, Washington, and University of Pittsburgh, Pittsburgh, Pennsylvania. and Sanjay R. Patel, MD, MSFrom University of Washington, Seattle, Washington, and University of Pittsburgh, Pittsburgh, Pennsylvania.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M16-2902 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Clinical sleep medicine emerged as a subspecialty around expertise in performing and billing for laboratory-based polysomnography. With the obesity epidemic and increasing recognition of obstructive sleep apnea (OSA), billing for overnight polysomnography has been one of the fastest-growing charges for third-party payers. In response, there has been a push for adoption of home sleep testing (HST) to reduce costs (1). In addition, the development of autotitrating continuous positive airway pressure (CPAP) has removed the need for in-laboratory CPAP titration studies, further reducing costs.Several randomized, controlled trials have shown that a strategy of HST and autotitrating CPAP is as effective ...References1. Pack AI. Dealing with a paradigm shift. J Clin Sleep Med. 2015;11:925-9. [PMID: 26094918] doi:10.5664/jcsm.4948 CrossrefMedlineGoogle Scholar2. Mulgrew AT, Fox N, Ayas NT, Ryan CF. Diagnosis and initial management of obstructive sleep apnea without polysomnography: a randomized validation study. Ann Intern Med. 2007;146:157-66. [PMID: 17283346]. doi:10.7326/0003-4819-146-3-200702060-00004 LinkGoogle Scholar3. Berry RB, Hill G, Thompson L, McLaurin V. Portable monitoring and autotitration versus polysomnography for the diagnosis and treatment of sleep apnea. Sleep. 2008;31:1423-31. 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Collop NA, Anderson WM, Boehlecke B, Claman D, Goldberg R, Gottlieb DJ, et al; Portable Monitoring Task Force of the American Academy of Sleep Medicine. Clinical guidelines for the use of unattended portable monitors in the diagnosis of obstructive sleep apnea in adult patients. Portable Monitoring Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med. 2007;3:737-47. [PMID: 18198809] CrossrefMedlineGoogle Scholar8. Chai-Coetzer CL, Antic NA, Hamilton GS, McArdle N, Wong K, Yee BJ, et al. Physician decision making and clinical outcomes with laboratory polysomnography or limited-channel sleep studies for obstructive sleep apnea. A randomized trial. Ann Intern Med. 2017;166:332-40. doi:10.7326/M16-1301 LinkGoogle Scholar9. Kim RD, Kapur VK, Redline-Bruch J, Rueschman M, Auckley DH, Benca RM, et al. An economic evaluation of home versus laboratory-based diagnosis of obstructive sleep apnea. Sleep. 2015;38:1027-37. [PMID: 26118558] doi:10.5665/sleep.4804 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From University of Washington, Seattle, Washington, and University of Pittsburgh, Pittsburgh, Pennsylvania.Acknowledgment: Dr. Nick Antic, a coauthor of the referenced article, recently passed away. We would like to acknowledge the many contributions of Dr. Antic to the field of sleep medicine, not the least of which was improving the care of patients with sleep apnea.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-2902.Corresponding Author: Sanjay R. Patel, MD, MS, UPMC Montefiore Hospital, NW628, 3459 Fifth Avenue, Pittsburgh, PA 15213; e-mail, [email protected]edu.Current Author Addresses: Dr. Donovan: Division of Pulmonary and Critical Care, University of Washington, 1959 NE Pacific Street, Campus Box 356522, Seattle, WA 98116.Dr. Patel: UPMC Montefiore Hospital, NW628, 3459 Fifth Avenue, Pittsburgh, PA 15213.This article was published at Annals.org on 10 January 2017. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoPhysician Decision Making and Clinical Outcomes With Laboratory Polysomnography or Limited-Channel Sleep Studies for Obstructive Sleep Apnea Ching Li Chai-Coetzer , Nick A. Antic , Garun S. Hamilton , Nigel McArdle , Keith Wong , Brendon J. Yee , Aeneas Yeo , Rajeev Ratnavadivel , Matthew T. Naughton , Teanau Roebuck , Richard Woodman , and R. Doug McEvoy Metrics Cited byClinician-Focused Overview and Developments in PolysomnographyFrequency of Loud Snoring and Metabolic Syndrome among Korean Adults: Results from the Health Examinees (HEXA) Study 7 March 2017Volume 166, Issue 5Page: 366-367KeywordsCardiovascular diseasesContinuous positive airway pressureDisclosureObstructive sleep apneaPatientsPolysomnographyResearch laboratoriesSleepSleep apneaTreatment guidelines ePublished: 10 January 2017 Issue Published: 7 March 2017 Copyright & PermissionsCopyright © 2017 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...