Skip to main content

Advertisement

SpringerLink
Log in

Reducing cost and time to diagnosis and treatment of obstructive sleep apnea using ambulatory sleep study: a Singapore sleep centre experience

  • Sleep Breathing Physiology and Disorders • Original ArticleSleep Breathing Physiology and Disorders • Original Article
  • Published:
Sleep and Breathing Aims and scope Submit manuscript

Abstract

Purpose

The current gold standard for diagnosis of obstructive sleep apnea (OSA) is overnight in laboratory polysomnography (PSG). However, PSGs are expensive, labor-intensive, and have long wait times. An ambulatory sleep study device, the WatchPAT, has been shown to have high correlation for sleep indices measured compared with PSG (AASM, 2016). Use of the WatchPAT could potentially lead to shorter waiting times and earlier diagnosis of OSA (Lancet Resp Med 3:310–8, 2015). Our study aimed to investigate if WatchPAT reduces time to diagnosis and treatment of OSA in a tertiary healthcare setting. A secondary aim was to investigate the cost-benefit of an ambulatory sleep study.

Methods

All patients who underwent diagnostic sleep studies in a single tertiary institution from 2014 to 2017 were retrospectively reviewed. Baseline characteristics and time from ordering of sleep study to prescription of continuous positive airway pressure were recorded. Data were categorized into two groups by type of diagnostic sleep study, PSG, and WatchPAT. The time to treatment and cost for diagnosis of OSA were compared between groups with the Paired T test/Wilcoxon signed-rank test.

Results

Of 1898 patients who had diagnostic sleep studies over a 4-year period, 1660 patients (88%) underwent PSG and 238 patients (12%) underwent WatchPAT. Patients in the WatchPAT group had a shorter time to diagnosis (21 days versus 79.8 days, p < 0.001) and treatment (46.3 days versus 118.4 days, p < 0.001) compared to the PSG group. Cost-benefit calculation showed that this earlier treatment led to cost-saving of US $1179.50 per patient.

Conclusion

An ambulatory sleep study is an option for earlier access to diagnosis and treatment of OSA with the potential of considerable cost savings.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Abbreviations

AHI:

Apnea-Hypopnea Index

BiPAP:

bilevel positive airway pressure

CPAP:

continuous positive airway pressure

OSA:

obstructive sleep apnea

PAT:

peripheral arterial tonometry

PSG:

polysomnography (PSG)

REM:

rapid eye movement

RDI:

Respiratory Disturbance Index

References

  1. Frost & Sullivan. Darien, IL: American Academy of Sleep Medicine; 2016. Hidden health crisis costing America billions. Underdiagnosing and undertreating obstructive sleep apnea draining healthcare system. Available from: http://www.aasmnet.org/sleep-apnea-economic-impact.aspx

  2. Heinzer R, Vat S, Marques-Vidal P, Marti-Soler H, Andries D, Tobback N, Mooser V, Preisig M, Malhotra A, Waeber G, Vollenweider P, Tafti M, Haba-Rubio J (2015) Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study. Lancet Respir Med 3:310–318

    Article  CAS  Google Scholar 

  3. Tan A, Cheung YY, Yin J, Lim WY, Tan LW, Lee CH (2016) Prevalence of sleep-disordered breathing in a multiethnic Asian population in Singapore: a community-based study. Respirology. 21(5):943–950

    Article  Google Scholar 

  4. Yalamanchali S, Farajian V, Hamilton C, Pott TR, Samuelson CG, Friedman M (2013) Diagnosis of obstructive sleep apnea by peripheral arterial tonometry: meta-analysis. JAMA Otolaryngol Head Neck Surg 139(12):1343–1350

    Article  Google Scholar 

  5. Collop NA, Anderson WM, Boehlecke B, Claman D, Goldberg R, Gottlieb DJ, Hudgel D, Sateia M, Schwab R, Portable Monitoring Task Force of the American Academy of Sleep Medicine (2007) 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 3(7):737–747

    Article  Google Scholar 

  6. Safadi A, Etzioni T, Fliss D, Pillar G, Shapira C (2014) The effect of the transition to home monitoring for the diagnosis of OSAS on test availability, waiting time, patients’ satisfaction, and outcome in a large health provider system. Sleep Disorders 2014:1–6

    Article  Google Scholar 

  7. Kapur VK, Auckley DH, Chowdhuri S, Kuhlmann DC, Mehra R, Ramar K, Harrod CG (2017) Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: an American Academy of Sleep Medicine Clinical Practice Guideline. J Clin Sleep Med 13(3):479–504

    Article  Google Scholar 

  8. Itamar Medical Ltd. WatchPAT Operational Manual. https://www.itamar-medical.com/support-downloads. Accessed Sep 29, 2019

  9. Yucege M, Firat H, Demir A, Sadik A (2013) Reliability of the WatchPAT 200 in detecting sleep apnea in highway bus drivers. J Clin Sleep Med 9(4):339–344

    Article  Google Scholar 

  10. Potts, KJ, DT Butterfield, P Sims, M Henderson, and CB Shames. “Cost savings associated with an education campaign on the diagnosis and management of sleep-disordered breathing: a retrospective, claims-based US study.” Population Health Magazine (2013): National Center for biotechnology information. U.S. National Library of Medicine

  11. World Health Organisation. Global Health Expenditure Database. http://apps.who.int/nha/database. Updated date: 22 March 2019. Accessed Date: 23 March 2019

  12. Rotenberg BW, George CF, Sullivan KMM, Wong E (2010) Wait times for sleep apnea care in Ontario: a multidisciplinary assessment. Can Respir J 17(4):170–174

    Article  Google Scholar 

  13. Safadi A, Etzioni T, Fliss D, Pillar G, Shapira C (2014) The effect of the transition to home monitoring for the diagnosis of OSAS on test availability, waiting time, patients’ satisfaction, and outcome in a large health provider system. Sleep Disorders 418246

  14. Xu H, Wang Y, Guan J, Yi H, Yin S (2015) Effect of CPAP on endothelial function in subjects with obstructive sleep apnea: a meta-analysis. Respir Care 60(5):749–755

    Article  Google Scholar 

  15. Davis AP, Billings ME, Longstreth WT Jr, Khot SP (2013) Early diagnosis and treatment of obstructive sleep apnea after stroke: are we neglecting a modifiable stroke risk factor? Neurol Clin Pract 3(3):192–201

    Article  Google Scholar 

  16. Harbison J, O'Reilly P, McNicholas WT (2000 Sep) Cardiac rhythm disturbances in the obstructive sleep apnea syndrome: effects of nasal continuous positive airway pressure therapy. Chest. 118(3):591–595

    Article  CAS  Google Scholar 

  17. Ryan CM, Usui K, Floras JS, Bradley TD (2005 Sep) Effect of continuous positive airway pressure on ventricular ectopy in heart failure patients with obstructive sleep apnoea. Thorax. 60(9):781–785

    Article  CAS  Google Scholar 

  18. Pillar G, Etzioni T, Berall M, Henkin et al (2019) 0502 Watchpat is accurate in the diagnosis of sleep apnea in the presence of atrial fibrillation. Sleep. 42:A201–A201

    Article  Google Scholar 

  19. Yuceege M, Firat H, Demir A, Ardic S (2013) Reliability of the watch-PAT 200 in detecting sleep apnea in highway bus drivers. J Clin Sleep Med 9(4):339–344

    Article  Google Scholar 

  20. O'Brien LM, Bullough AS, Shelgikar AV, Chames MC, Armitage R, Chervin RD (2012) Validation of watch-PAT-200 against polysomnography during pregnancy. J Clin Sleep Med 8(3):287–294

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Otolaryngology (Ear, Nose and Throat Surgery), Sengkang General Hospital, Singapore, Singapore

    Chu Qin Phua

  2. Department of Otorhinolaryngology-Head and Neck Surgery, Singapore General Hospital, Singapore, Singapore

    Isabelle JH Jang & Song Tar Toh

  3. NUS Saw Swee Hock School of Public Health, Centre of Regulatory Excellence, Duke-NUS, Policy Research and Evaluation Division, Data Analytics Group, Ministry of Health, Singapore, Singapore

    Kelvin Bryan Tan

  4. Health Services Research Centre (HSRC), Singapore Health Services, Singapore, Singapore

    Ying Hao

  5. Sleep Technologist, Sleep Centre, Singapore General Hospital, Singapore, Singapore

    Siti Raudha Bte Senin & Pei Rong Song

  6. Department of General Medicine (Respiratory), Sengkang General Hospital, Singapore, Singapore

    Rui Ya Soh

  7. Singhealth Duke-NUS Sleep Centre, Singhealth, Outram Road, Singapore, 169608, Singapore

    Song Tar Toh

Authors
  1. Chu Qin Phua
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Isabelle JH Jang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kelvin Bryan Tan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ying Hao
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Siti Raudha Bte Senin
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Pei Rong Song
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Rui Ya Soh
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Song Tar Toh
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Isabelle JH Jang or Song Tar Toh.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Research involving human participants and/or animals

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

As this was a retrospective study, all investigations and treatment were done as part of routine clinical practice with informed consent from all patients. Retrieval of database clinical parameters were approved by the Singhealth Institutional Review Board.

All authors have seen and approved the manuscript.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

ESM 1

(PDF 78 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Phua, C.Q., Jang, I.J., Tan, K.B. et al. Reducing cost and time to diagnosis and treatment of obstructive sleep apnea using ambulatory sleep study: a Singapore sleep centre experience. Sleep Breath 25, 281–288 (2021). https://doi.org/10.1007/s11325-020-02115-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11325-020-02115-z

Keywords

Search

Navigation