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. 2018 Apr 15;14(4):631-639.
doi: 10.5664/jcsm.7060.

Analyses of the Complexity of Patients Undergoing Attended Polysomnography in the Era of Home Sleep Apnea Tests

Brendon Colaco  1   2 , Daniel Herold  1 , Matthew Johnson  3 , Daniel Roellinger  3 , James M Naessens  3   4 , Timothy I Morgenthaler  1   2
Affiliations

Analyses of the Complexity of Patients Undergoing Attended Polysomnography in the Era of Home Sleep Apnea Tests

Brendon Colaco et al. J Clin Sleep Med. .

Abstract

Study objectives: Health care complexity includes dimensions of patient comorbidity and the level of services needed to meet patient demands. Home sleep apnea tests (HSAT) are increasingly used to test medically uncomplicated patients suspected of having moderate to severe obstructive sleep apnea (OSA). Patients with significant comorbidities or other sleep disorders are not candidates for HSAT and require attended in-center polysomnography. We hypothesized that this trend would result in increasingly complex patients being studied in sleep centers.

Methods: Our study had two parts. To ascertain trends in sleep patient comorbidity, we used administrative diagnostic codes from patients undergoing polysomnography at the Mayo Clinic Center for Sleep Medicine from 2005 to June 2015 to calculate the Charlson and the Elixhauser comorbidity indices. We measured the level of services provided in two ways: (1) in a subset of patients from the past 2 months of 2015, we evaluated correlation of these morbidity indices with an internally developed Polysomnogram Clinical Index (PSGCI) rating anticipated patient care needs from 0 to 3 and (2) we measured the sleep study complexity based on polysomnography protocol design.

Results: In 43,780 patients studied from 2005 to June 2015, the Charlson index increased from a mean of 1.38 to 1.88 (3.1% per year, P < .001) and the mean Elixhauser index increased from 2.61 to 3.35 (2.5% per year, P < .001). Both comorbidity indices were significantly higher at the highest (Level 3) level of the PSGCI (P < .001), and sleep study complexity increased over time.

Conclusions: The complexity of patients undergoing attended polysomnography has increased by 28% to 36% over the past decade as measured by validated comorbidity indices, and these indices correlate with the complexity of rendered care during polysomnography. These findings have implications for increasing requirements for staffing, monitoring capabilities, and facility design of future sleep centers.

Commentary: A commentary on this article appears in this issue on page 499.

Keywords: complexity; health services; home sleep apnea tests; morbidity; polysomnography; sleep medicine; technologist.

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Figures

Figure 1
Figure 1. Schema of the Polysomnogram Clinical Index.
Figure 2
Figure 2. Slope of the Charlson comorbidity and Elixhauser index over a 10-year period.
Charlson index regression: y = 0.02938 x + 57.464, R2 = 0.0016; Elixhauser Index regression: y = 0.04546 x + 88.488, R2 = 0.0027.
Figure 3
Figure 3. Mean Charlson and Elixhauser indices at different PSGCI values.
* = P < .001 compared with index values for PSGCI = 0, 1, or 2. PSGCI = Polysomnogram Clinical Index.
See this image and copyright information in PMC

Comment in

  • The Future of the Sleep Lab: It's Complicated.
    Orr JE, DeYoung PN, Owens RL. Orr JE, et al. J Clin Sleep Med. 2018 Apr 15;14(4):499-500. doi: 10.5664/jcsm.7028. J Clin Sleep Med. 2018. PMID: 29609726 Free PMC article. No abstract available.

References

    1. Collop NA, Anderson WM, Boehlecke B, et al. 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(7):737–747. - PMC - PubMed
    1. Kim RD, Kapur VK, Redline-Bruch J, et al. An economic evaluation of home versus laboratory-based diagnosis of obstructive sleep apnea. Sleep. 2015;38(7):1027–1037. - PMC - PubMed
    1. Parish JM, Freedman NS, Manaker S. Evolution in reimbursement for sleep studies and sleep centers. Chest. 2015;147(3):600–606. - PubMed
    1. Sleep Facility Accreditation. Standards for Accreditation (pdf) American Academy of Sleep Medicine website. [Accessed November 19, 2016]. https://aasm.org/accreditation/facility-accreditation/. Published November 2016.
    1. Fragala G. Reducing occupational risk to ambulatory caregivers. Workplace Health Saf. 2016;64(9):414–419. - PubMed