0484 Repeat Home Sleep Apnea Testing (HST) For Technically Inadequate Initial HST

Abstract

Introduction: A portion of the HSTs are non-diagnostic due to technical failure, resulting from malfunction of any of the sensors as well as insufficient recording time. The Oklahoma City VA medical center has a HST program. In-lab sleep study costs significantly more than HST, as patients require referral to a community Sleep lab. Diagnostic yield of repeat HST for a technically inadequate test is not well known. We hypothesized that repeating HST would be cost effective due to high diagnostic yield. Method(s): We conducted a retrospective chart review of patients who had a non-diagnostic HST study done between period of April 2017 to August 2017 (4 months) as a part of Quality & improvement project. Request to repeat HST was placed for all these patients. We collected demographic data as well as outcome of repeat HST. HSTs were performed using either Apnea link or Stardust systems which are type III portable equipment devices. A technically adequate diagnostic test included a minimum of 4 hours of technically adequate oximetry and flow data. All studies were scored based on criteria per the AASM scoring manual. Result(s): Total 454 HSTs were performed during study period. There were 52 non-diagnostic studies (12%). Mean age of patients was 51 and mean BMI was 33. Most subjects were male (45). Non-diagnostic initial studies were due to failure of pulse oximeter (57%) followed by insufficient recording time (36%) and failure of flow channel (32%). 19% of patients had a failure of 2 channels. Repeat HST was performed in 31 (60%) of the patients. Drop out was largely due to either no show or refusal. We found that 65% of repeat HST was technically adequate (diagnostic). Conclusion(s): Diagnostic yield of repeat HST is reasonably good and can be cost effective at a VA medical center. However, there is a high dropout rate which should be addressed in the future.