Abstract
Abstract Introduction The Department of Veterans Affairs has pioneered the use of home sleep apnea testing (HSAT) across many of its medical centers over the past 15 years. Here we report trends regarding diagnostic sleep apnea testing in rural and urban Veterans served by the TeleSleep Program, a VA telehealth initiative focused on increasing access to sleep care for rural Veterans. Rurality is a risk factor for use of polysomnography and is associated with longer wait times for testing and initiation of PAP therapy. Methods We used a VA administrative database search of patients enrolled in sleep medicine clinics from fiscal years (FY) 2016-2019 at 7 TeleSleep Hubs: San Francisco, Portland, Phoenix, Boise, Philadelphia, Spokane, and Pittsburgh. Individual encounters were coded locally and transmitted to VA’s corporate data warehouse. HSAT codes included 95800, 95801, 95806, G0398, G0399, and G0400. Polysomnography codes included 95807, 95808, 95810, and 95811. Results Total number of unique Veterans served increased between FY16 and FY19 from 28,941 to 43,044 (149%); rural Veterans served during this time increased from 9,386 to 14,329 (153%). The total number of annual sleep medicine encounters for all Veterans served increased from 89,870 to 138,127 (154%); rural Veteran visits increased from 29,825 to 50,342 (169%). Unique urban Veterans tested by HSAT increased from 2,158 in FY16 to 4,398 in FY19 (203%) while polysomnography decreased from 5,011 to 3,253 (35%). Unique rural Veterans tested by HSAT increased from 1,102 to 2,768 (251%) and polysomnography decreased by 42% (1,565 to 909 Veterans) during this same time. Conclusion Among VA sleep medicine programs with TeleSleep funding, HSAT became the most common approach to diagnostic sleep apnea testing, particularly in rural Veterans. Although polysomnography was widely used at the beginning of the TeleSleep Initiative, use declined as HSAT became more widely implemented. Support VA Office of Rural Health
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