In-home vs. In-lab Polysomnography

September 18, 2017

According to a 2016 Frost & Sullivan report, the prevalence of obstructive sleep apnea is on the rise: 13 percent of the U.S. adult population, totaling more than 29 million Americans, is afflicted with it.

With this rising prevalence comes increased cost burdens to the health care and economic landscapes: Frost & Sullivan calculated the annual economic burden of undiagnosed sleep apnea among U.S. adults as more than $149 billion, with an additional $30 billion in costs from increased health care utilization and medical costs related to comorbid health risks from undiagnosed cases.1

Diagnosing and treating sleep apnea early can bring down these costs. This is where polysomnography comes in; the detailed, overnight evaluations can provide invaluable information about the activity of the body and brain during sleep. Traditionally, this sleep study has been performed in a fully outfitted sleep lab. Today, new technology allows limited polysomnography to be performed at home with portable monitoring devices.

But is an in-home polysomnography best for patients? Both methods have pros and cons.

In-lab Polysomnography

With the in-lab sleep study, the patient spends the night at the facility and the procedure is performed by a registered polysomnographic technologist (PRSGT).

The monitoring PRSGT can ensure everything runs correctly and the patient follows protocol throughout the study. The in-lab test measures brainwave activity as well, which can’t be measured during an in-home study.2 Because the in-lab study uses more sensors than its in-home counterpart, it gathers more accurate data and can provide accurate results for a number of sleep disorders in addition to sleep apnea. These results are then given to the patient and ordering physician the day the test is administered or the next day at the latest.

However, there are some drawbacks—or cons—to the in-lab study. The first and most significant: On average, in-lab sleep tests cost $3,000 or more.3

Second in the level of drawback is the inconvenience factor for patients. The facility may be far away, creating expense and inconvenience. Further, it typically takes weeks or months to get scheduled in a lab. Anything that causes the patient difficulty may cause him or her to rethink undergoing this important evaluation.

And finally, although many facilities offer high-quality bedding, warm and homey furniture and décor, and minimal hospital equipment in the room, the rooms still aren’t home—and aren’t as comfortable as sleeping in one’s own bed.

In-home Polysomnography

Alternatively, physicians can order a portable monitor that the patient will pick up from the office, learn how to operate, and take home for the polysomnography. For in-home tests, patients typically affix just a finger oxygen probe, a chest belt, and a nasal tube before going to sleep.

The top benefit of the home sleep study is the inverse of the biggest drawback for in-lab studies: The in-home study usually costs less than $600.3 This affordability is why payers are increasingly moving toward covering in-home sleep tests before covering in-lab tests.

The requirements for an in-home sleep study are less cumbersome than for an in-lab study, and patients can schedule them for any night that is convenient. Because no travel is involved, in-home tests are especially advantageous for the home-bound, elderly, or people with many chronic illnesses. Further, the in-home test is administered in the comfort and privacy of the patient’s bedroom, and it involves far fewer wires than with a traditional in-lab sleep study, so the patient can get a better night’s sleep.

And in what is perhaps the most important positive of in-home polysomnography for clinicians, in-home sleep studies have high accuracy in diagnosing people with a significant likelihood of having OSA.4

Yet the in-home sleep study has its drawbacks. This type of study only measures the heart rate, blood oxygen level, airflow, and breathing patterns—not actual sleep. Its results can underestimate the severity of the condition, because it doesn’t typically measure actual sleep time like an in-lab study does, throughout which electroencephalogram sensors objectively measure sleep duration.4 And if a sensor falls off or becomes faulty, a tech isn’t there to fix it; in these cases, patients may require repeat studies.

Further, in-home studies can’t detect other sleep disorders: In-home sleep studies are limited to the diagnosis of OSA and are contraindicated for individuals with other conditions, such as congestive heart failure, chronic obstructive pulmonary disease, periodic limb movements of sleep, and other disorders.

Because of this limited scope, only patients already assumed at high risk for moderate or severe sleep apnea should use the in-home option. People with preexisting conditions, such as lung disease, hypoventilation, heart failure, or other sleep disorders, aren’t candidates for home testing.

Selecting the Best Course

Which is best? The answer depends on the patient and the situation. HealthHelp’s sleep program is a collaborative-care approach that works with the patient’s physician to choose the most medically appropriate OSA diagnostic study. HealthHelp works with physicians to order the right test the first time, reducing the number of duplicate tests and ensuring the best use of health care dollars while improving patient outcomes.

HealthHelp’s sleep program features the following benefits:

  • Appropriate triage between in-lab or in-home tests by applying evidence-based OSA clinical criteria, achieving up to 40 percent impact.
  • Eliminating unnecessary testing for detecting low to severe sleep apnea, improving diagnostic efficiency and treatment.
  • Compliance CPAP/BiPAP therapies.
  • Ensuring that in-lab sleep tests are performed in certified facilities assessed for safety and quality.

HealthHelp’s model is based on nondenial of services, meaning that it does not deny treatment requests from a member’s physician, instead consulting with him or her to collaboratively determine the best form of diagnosis or treatment. Network physicians prefer this nondenial, collaboration-focused approach, and this approach helps payers ensure members receive the appropriate treatments at the right times. Overall, HealthHelp’s program improves patient outcomes while lowering the cost of care.

The results? Increased safety and quality for the plan member and sustained savings for the payer through lowered cost of comorbidities due to OSA and decreased double-testing rates.5

Contact HealthHelp at 800-405-4817 or visit http://www.healthhelp.com/sleep-care/ for more information.

 

Sources:

“What is a home sleep test? Advantages, disadvantages, and procedures,” SomnoSure Education Center, June 23, 2015. https://www.somnosure.com/blog/what-is-home-sleep-test-advantages-disadvantages-procedures-missouri

“How much will a sleep study cost me?” Advanced Sleep Medicine Services, Inc. https://www.sleepdr.com/the-sleep-blog/how-much-will-a-sleep-study-cost-me/

“In-Lab Sleep Study versus Home Sleep Test,” Alaska Sleep Education Center, Augus 19, 2016. http://www.alaskasleep.com/blog/in-lab-sleep-study-versus-home-sleep-test

4 “Economic burden of undiagnosed sleep apnea in U.S. is nearly $150B per year,” American Academy of Sleep Medicine, August 8, 2016. http://www.aasmnet.org/articles.aspx?id=6426

“Sleep care: Addressing obstructive sleep apnea,” HealthHelp. http://www.healthhelp.com/sleep-care/

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