When a private community neurology practice executes home sleep apnea testing: benefits identified and lessons learned in a retrospective observational study

Objective: To investigate the feasibility and utility of a private community neurology practice–initiated home sleep apnea testing (HSAT) program. Methods: A private community neurology practice conducted HSAT on patients clinically identified as high risk for obstructive sleep apnea (OSA). An academic board-certified sleep specialist performed all study interpretations. The presence and severity of OSA and its association with patient demographics (eg, sex, age) and comorbid health conditions relevant to OSA were evaluated. Results: During 2011-2014, 147 consecutive patients clinically identified as highly “at risk for OSA” during their neurological visit underwent HSAT. Sixty-one percent (n = 89) of patients had a “positive” study with evidence of an apnea-hypopnea index of greater than 5 events per hour. Of those, 37% (n = 54) had mild OSA and 24% (n = 35) had moderate-severe OSA. OSA was more common among men (54%, n = 48) and in individuals with a previous documented history of depression (33%, n = 48) and hypertension 44% (n = 64). OSA treatment was ordered in 44% (n = 39) of patients by the neurologists or by a sleep specialist. Twenty-four percent (n = 21) of all patients studied were referred to a sleep specialist. Conclusion: Implementation of HSAT in a (nonsleep) private community neurology practice in collaboration with an academic sleep program is recommended. Based on this observational study, community-based neurological practices and board-certified sleep specialists should consider teaming up to develop HSAT collaborative programs to open new sleep care access pathways for neurological patients often at risk for sleep apnea.