Analyses of the complexity of patients undergoing attended polysomnography in the era of home sleep apnea tests

Brendon Colaco, Daniel Herold, Matthew Johnson, Daniel Roellinger, James M Naessens, Timothy Ian Morgenthaler

Research output: Contribution to journalArticle

2 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)631-639
Number of pages9
JournalJournal of Clinical Sleep Medicine
Volume14
Issue number4
DOIs
StatePublished - Apr 15 2018

Fingerprint

Polysomnography
Sleep Apnea Syndromes
Systems Analysis
Comorbidity
Sleep
Facility Design and Construction
Obstructive Sleep Apnea
Patient Care
Medicine
Morbidity
Delivery of Health Care

Keywords

  • Complexity
  • Health services
  • Home sleep apnea tests
  • Morbidity
  • Polysomnography
  • Sleep Medicine
  • Technologist

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Neurology
  • Clinical Neurology

Cite this

Analyses of the complexity of patients undergoing attended polysomnography in the era of home sleep apnea tests. / Colaco, Brendon; Herold, Daniel; Johnson, Matthew; Roellinger, Daniel; Naessens, James M; Morgenthaler, Timothy Ian.

In: Journal of Clinical Sleep Medicine, Vol. 14, No. 4, 15.04.2018, p. 631-639.

Research output: Contribution to journalArticle

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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.",
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AU - Morgenthaler, Timothy Ian

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