Abstract
Abstract Introduction The volume and diversity of sleep-related and quality of life complaints in sleep medicine has increased through improved availability of data from wearables and public education on sleep health. Future shifts away from quantity and towards quality-based compensation by insurance payors will require practices to understand and actively monitor population health and outcomes data and implement data-driven practices to improve diagnostic efficiency. Currently, prevalence and population health data benchmarks are incomplete or absent in many aspects of sleep disorders treatment. The integrated care model of sleep medicine, with board-certified primary sleep physicians, an in-house Positive Airway Pressure (PAP) Therapy clinic and certified sleep medicine Dentist, is uniquely positioned to improve care by characterizing the impact of clinical decision-making on care cost and quality. Methods Population health data was gathered in the course of patient care in the integrated care model. Baseline/Diagnostic Home Sleep Apnea Test (HSAT) results from 2018-2021 were included. Diagnostic severity was categorized based on AASM treatment guidelines. Matched therapy visits were included from PAP Therapy Initiation or Compliance visit and treatment outcomes, as well as non-PAP treatments for sleep-disordered breathing, Oral Appliance (OA) and Inspire Therapy. Results 20% of 8531 Diagnostic HSAT results were non-diagnostic for sleep apnea, 35% were Mild, 21% Moderate and 24% Severe. Of non-diagnostic tests, 81% had no sleep apnea treatment associated. Of Mild diagnostic tests, 49% had associated PAP initiation or compliance, 9% had associated OA, and 42% had no treatment associated. The relationship between diagnostic severity and associated treatment was significant (Χ2 < 0.0001). Further, Moderate and Severe resulting diagnostic tests had no associated treatment in 24% and 28% of cases, respectively. Conclusion Sleep medicine patients are commonly symptomatic and often have major quality of life complaints. Yet as these data demonstrate, there is a substantial proportion of patients who do not have an associated treatment after a positive diagnostic home sleep apnea test. Future studies should include additional demographic and follow up data to better understand care pathways both for patients who receive a positive diagnostic test but pursue alternative treatment methods, as well as more complicated non-diagnostic sleep disorders patients. Support (if any)
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