Sleep Apnea: Skipping Sleep Lab Found Cost-Effective
Written by Editor   
Wednesday, May 21, 2014 12:00 AM

Home management of obstructive sleep apnea (OSA) appeared cost-effective in a VA trial.  Sending patients home with the testing and CPAP titration devices saved an average of $564 in costs per patient compared with laboratory based diagnosis and titration.

The Veterans Sleep Apnea Treatment Trial had previously demonstrated, as have multiple other randomized controlled trials, that the outcomes are equivalent between portable sleep testing and auto-CPAP titration carried out at home and lab-based polysomnography and titration.

In this VA study, the biggest difference in cost was accounted for by the testing itself ($914 home versus $2,043 in-lab), whereas equipment and follow-up management were a little more costly with home management.

The 296 suspected sleep apnea patients in that trial came into the center for initial assessment and were randomized to either get sent home with the testing device and then a home auto-CPAP titration device or to have the in-lab polysomnography and CPAP set-up.

"In sleep apnea, I think we know enough now to project with good likelihood the pretest probability of a test, assess the patient's willingness to try therapy or be willing to have portable therapy and at home approaches, understanding that if they don't work out, we can bring them back to the laboratory,"