Economic Assessment of 4 Approaches to the Diagnosis and Initial Treatment of Sleep Apnea

Bravata, Dawn M.; Lightner, Nancy J.; Yaggi, H. Klar; Miech, Edward J.

doi:10.4187/respcare.05355

Cited by 6 publications

(5 citation statements)

References 24 publications

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“…Such an adaptive set of guidelines would then enable clinicians to operationalize their approach at the individual patient level. Interestingly, the financial resources and professional efforts eventually spared by avoiding CPAP titration in most OSA patients (only a minority of complex patients or those situated in the edges of the Gaussian distribution shown in Figure 1 would require individualized assessment after initial CPAP trial) could be reinvested into OSA patients; for instance, to expand the access to diagnose the disease, which is also a costly procedure [7], or to implement programs aimed at improving CPAP patient's adherence [28,29].…”

Section: Potential Applicability Of the Proposed Approachmentioning

confidence: 99%

“…At the time of CPAP discovery, the number of patients was quite low, since awareness of OSA was barely developing, and as such, personalized CPAP titration did not pose major problems. Nowadays, in light of the considerable number of patients who suffer from OSA [ 5 , 6 ], individual CPAP titration has become a major logistic and financial burden [ 7 ]. Fortunately, CPAP titration can be simplified by approaches that do not require full in-hospital polysomnography (PSG), such as relying on respiratory polygraphy or using automatic CPAP devices at home.…”

Section: Introductionmentioning

confidence: 99%

“…Fortunately, CPAP titration can be simplified by approaches that do not require full in-hospital polysomnography (PSG), such as relying on respiratory polygraphy or using automatic CPAP devices at home. Nevertheless, even when employing these simplified approaches, the burden of CPAP titration remains considerable for health care systems [ 7 ]. Remarkably, this problem will continue to escalate in the future with the global epidemic of obesity [ 8 ] and the increased ageing of the population, both of which are well known to enhance OSA prevalence and severity [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

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Alternative Procedure to Individual Nasal Pressure Titration for Sleep Apnea

Farré

Gozal

Montserrat

2021

JCM

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In the treatment of obstructive sleep apnea (OSA), the current standard of “CPAP titration” in the laboratory or at home is a resource demanding and costly approach that, in developed economies, markedly augments healthcare costs and in low resource economies precludes access to care altogether. Here, we discuss that current guidelines for titration of CPAP could be obviated by taking a different route that in many ways is similar to the institution of treatment in many other medical conditions. To this effect, we present novel population based data from 16,780 patients, showing that after individualized and labor-intensive and expensive CPAP titration, 86.4% of OSA patients are treated with nasal pressure settings within the range of 9 ± 2 cmH2O, and review the literature to justify the potential adoption of a standard therapeutic CPAP setting as the initial intervention which would be subsequently followed by any necessary adjustments in only a minority of patients who would not derive the necessary benefit from such standardized intervention. Assuming an 80–85% success rate as derived from our analyses, our personal view if extensively adopted could radically reduce healthcare costs and enable markedly improve access to diagnostics.

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Section: Potential Applicability Of the Proposed Approachmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Alternative Procedure to Individual Nasal Pressure Titration for Sleep Apnea

Farré

Gozal

Montserrat

2021

JCM

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“…There are 1.5 million veterans diagnosed with OSA in the United States today. These numbers are only increasing as OSA disease prevalence has doubled with the explosive 6-fold growth of this population in recent years (Bravata, Lightner, Yaggi, & Miech, 2018;Jackson et al, 2017). Additionally, the veteran population is at an inherently increased risk for OSA due to the high proportion of males, increasing age, and prevalence of obesity (Bravata et al, 2018).…”

Section: Problem Descriptionmentioning

confidence: 99%

“…These numbers are only increasing as OSA disease prevalence has doubled with the explosive 6-fold growth of this population in recent years (Bravata, Lightner, Yaggi, & Miech, 2018;Jackson et al, 2017). Additionally, the veteran population is at an inherently increased risk for OSA due to the high proportion of males, increasing age, and prevalence of obesity (Bravata et al, 2018). This risk was demonstrated in an analysis of Mission Valley primary care male veterans with diagnoses of HTN and DM that revealed a majority (51%) of this population had a concurrent diagnosis of OSA.…”

Section: Problem Descriptionmentioning

confidence: 99%

What’s Keeping America’s Heroes Awake? Screening for Obstructive Sleep Apnea in Male Veterans with Hypertension and Diabetes

Stirling¹

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Purpose: To reduce cardiovascular risk through optimal obstructive sleep apnea (OSA) management with proactive screening utilizing the Epworth Sleepiness Scale (ESS) in male Veterans with hypertension (HTN) and diabetes mellitus (DM). Background: OSA is a common finding in primary care, with 1 in 5 adults feeling its effects: excessive sleepiness, impaired cognition, reduced quality of life and increased mortality. Unmanaged OSA has been highly correlated with increased cardiac risk in populations with chronic diseases such as HTN and DM. Fortunately, identification and treatment of OSA has been shown to improve cardiovascular outcomes and reduce mortality. Evidence supports outpatient screening to identify patients at risk for OSA, in order to more effectively manage future cardiovascular risk. Strategy and Implementation: Analyzing an existing database of 146 outpatient male veterans with HTN and DM, revealed that 52% have an existing OSA diagnosis, while the remainder have not been screened. The Doctor of Nursing Practice (DNP) student will screen these remaining patients for OSA via telephone utilizing the ESS tool. Based on findings, the DNP student will provide evidence-based guidance for further management of OSA to the care team. Evaluation/Outcomes: Post telephone screening intervention, the DNP student would expect a 40-50% increase in completed OSA screenings by January 2018.

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Home polysomnography with self-appliable systems for the diagnosis of sleep disorders

Heiser,

Jira,

Schoebel

et al. 2023

Somnologie

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Zusammenfassung Hintergrund Zur Differenzialdiagnose von Schlaferkrankungen ist die Polysomnographie (PSG) im Schlaflabor als Goldstandard der Diagnostik anerkannt. Aufgrund verschiedener Faktoren ist der Zugang zu dieser Untersuchung für Patienten teilweise eingeschränkt oder mit langen Wartezeiten verbunden. Als alternatives Verfahren zur Messung des Schlafes steht die häusliche PSG zur Verfügung, die in den letzten Jahren technisch weiterentwickelt wurde. Ziel der Arbeit Im Rahmen dieser Übersicht sollen technische Entwicklungen auf dem Gebiet der häuslichen PSG mit vom Patienten selbstständig zu applizierenden Systemen dargestellt und in den aktuellen Versorgungskontext eingeordnet werden. Material und Methoden Mittels einer Recherche in Literatur- sowie Zulassungsdatenbanken für Medizinprodukte wurden verfügbare PSG-Systeme identifiziert, die eine Selbstapplikation durch Patienten vorsehen. Informationen zu den einzelnen Systemen wurden aus der Literatur generiert und durch Herstellerangaben validiert. Der Stand der Forschung zur häuslichen PSG wurde über eine Literatursuche erhoben. Ergebnisse Momentan sind vier PSG-Systeme verfügbar, die für eine Selbstapplikation durch Patienten zuhause entwickelt wurden. Drei dieser Systeme ermöglichen eine direkte Messung des Schlafs analog zur PSG im Schlaflabor. Verschiedene Studien konnten identifiziert werden, welche die technische Umsetzbarkeit mit einer Erfolgsrate von > 80 % belegen und eine hohe Korrelation mit der PSG im Schlaflabor aufzeigen, was das Potenzial für eine breitere Anwendung dieses Verfahrens zur Entlastung stationärer Einrichtungen demonstriert. Weitere Studien sind jedoch notwendig, um die Leistungsfähigkeit der neuen Systeme in der deutschen Versorgungslandschaft zu bestätigen und die Gleichwertigkeit gegenüber etablierten Tests zu validieren. Schlussfolgerung Die häusliche PSG mit selbstapplizierten Systemen stellt eine interessante Weiterentwicklung der schlafmedizinischen Diagnostik dar, welche zukünftig positive Effekte auf die Versorgung in Deutschland haben könnte.

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Economic Assessment of 4 Approaches to the Diagnosis and Initial Treatment of Sleep Apnea

Abstract: Approaches to diagnosing and treating sleep apnea that emphasized early application of auto-PAP had lower per-patient costs.

Cited by 6 publications

References 24 publications

Alternative Procedure to Individual Nasal Pressure Titration for Sleep Apnea

Alternative Procedure to Individual Nasal Pressure Titration for Sleep Apnea

What’s Keeping America’s Heroes Awake? Screening for Obstructive Sleep Apnea in Male Veterans with Hypertension and Diabetes

Home polysomnography with self-appliable systems for the diagnosis of sleep disorders

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