title: Who is getting tested for obstructive sleep apnea using a portable recording system? Test results from 193,221 patients.
abstract: OBJECTIVE
  To address some of the questions about "who" has been tested for OSA (in terms of pretest risk and study outcomes) using a leading national portable recorder (PR; "home sleep test").
  
  
  METHODS
  This was a retrospective analysis of a large repository of de-identified test results and pretest OSA risk from 2009 to 2013.
  
  
  METHODS
  A total of 244,602 patients were referred for testing from a variety of clinical practices across North America. A total of 193,221 studies were included in the final analyses.
  
  
  METHODS
  NA.
  
  
  RESULTS
  The final sample was predominately male (59%), middle-aged (53.5 ± 14.2 years), obese (BMI >30; 54%), with a large neck circumference (males = 16.9 ± 1.2 in; females = 15.0 ± 1.3 in) and a mild degree of reported sleepiness (ESS 8.7±5.3). Approximately 50% of the sample endorsed a history of hypertension. The majority of patients (89.6%) were at a high risk for OSA as assessed by the ARES screening questionnaire. Of this group, 79.9% had an AHI ≥5 (MAHI = 18.2 ± 18.1) and 98% had an RDI ≥5 (MRDI = 28.0 ± 19.6). The majority of patients (~60%) that screened at no apparent risk for OSA indeed had AHIs <5 events/h. Those with a high pretest risk for OSA but low test outcomes (AHI <5) were twice as likely to be female and approximately 20% to 30% more likely to report a history of insomnia, lung disease, and/or stroke.
  
  
  CONCLUSIONS
  The majority of PR has been conducted on patients with a high degree of suspicion for OSA. These data suggest that PR has been used in patients with a high pretest probability of OSA. Patients with a history of insomnia, stroke, and/ or lung disease may especially benefit by a comprehensive evaluation by a physician trained in sleep medicine, especially if PR results are negative for OSA. Future studies should evaluate the utility of gender-appropriate screening measures. Although questionnaire-based screening is helpful in determining OSA risk, it is imperative that it be used in conjunction with clinical decision-making.
authors.affiliation: SleepMed, Inc. Columbia, SC.
authors.forename: Alyssa
authors.initials: A
authors.lastname: Cairns
authors.affiliation: SleepMed, Inc. Columbia, SC.
authors.forename: Greg
authors.initials: G
authors.lastname: Poulos
authors.affiliation: SleepMed, Inc. Columbia, SC and The University of South Carolina Medical School, Columbia, SC and The Medical University of South Carolina, Charleston, SC.
authors.forename: Richard
authors.initials: R
authors.lastname: Bogan
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D015897:Comorbidity; D003430:Cross-Sectional Studies; D004867:Equipment Design; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D016015:Logistic Models; D008171:Lung Diseases / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D018670:Monitoring, Ambulatory / Q000295:instrumentation* / Q000379:methods; D008991:Monitoring, Physiologic / Q000295:instrumentation*; D015999:Multivariate Analysis; D009765:Obesity / Q000453:epidemiology; D016017:Odds Ratio; D019095:Point-of-Care Systems; D017286:Polysomnography / Q000295:instrumentation*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000453:epidemiology; D020521:Stroke / Q000453:epidemiology; D014741:Video Recording / Q000295:instrumentation
keywords: ARES; Home sleep test; OCST; portable monitor; sleep apnea