title: Unattended Sleep Studies in a VA Population: Initial Evaluation by Chart Review Versus Clinic Visit by a Midlevel Provider.
abstract: OBJECTIVE
  Obstructive sleep apnea (OSA) is a prevalent disorder that is associated with multiple medical consequences. Although in-laboratory polysomnography is the gold standard for the diagnosis of OSA, portable monitors have been developed and studied to help increase efficiency and ease of diagnosis. We aimed to assess the adequacy of a midlevel provider specializing in sleep medicine to risk-stratify patients for OSA based on a chart review versus a comprehensive clinic evaluation before scheduling an unattended sleep study.
  
  
  METHODS
  This study was an observational, nonrandomized, retrospective data collection by chart review of patients accrued prospectively who underwent an unattended sleep study at the Sleep Health Center at the Memphis Veterans Affairs Medical Center during the first 13 months of the program (May 1, 2011-May 31, 2012). A total of 205 patients were included in the data analysis.
  
  
  RESULTS
  Analysis showed no statistically significant differences between chart review and clinic visit groups (P= 0.54) in terms of OSA diagnosis. Although not statistically significant, the analysis shows a trend toward higher mean age (50.3 vs 47.4 years;P= 0.10) and lower mean body mass index (34.4 vs 36.0;P= 0.08) in individuals who were evaluated during a comprehensive clinic visit. A statistically significant difference is seen in terms of the pretest clinical probability of OSA being moderate or high in 62.2% of patients in the clinic visit group and 95.7% in the chart review group, with a χ2P≤ 0.0001.
  
  
  CONCLUSIONS
  In the Veterans Health Administration's system, the assessment of pretest probability may be determined by a midlevel provider using chart review with equal efficacy to a comprehensive face-to-face evaluation in terms of OSA diagnosis via unattended sleep studies.
authors.affiliation: From the Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Tennessee Health Science Center, Memphis, and the Sleep Disorders Center, Memphis Veterans Administration Medical Center, Memphis, Tennessee.
authors.forename: Abdelhamid M
authors.initials: AM
authors.lastname: Alsharif
authors.affiliation: From the Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Tennessee Health Science Center, Memphis, and the Sleep Disorders Center, Memphis Veterans Administration Medical Center, Memphis, Tennessee.
authors.forename: Michelle
authors.initials: M
authors.lastname: Potts
authors.affiliation: From the Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Tennessee Health Science Center, Memphis, and the Sleep Disorders Center, Memphis Veterans Administration Medical Center, Memphis, Tennessee.
authors.forename: Regina
authors.initials: R
authors.lastname: Laws
authors.affiliation: From the Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Tennessee Health Science Center, Memphis, and the Sleep Disorders Center, Memphis Veterans Administration Medical Center, Memphis, Tennessee.
authors.forename: Amado X
authors.initials: AX
authors.lastname: Freire
authors.affiliation: From the Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Tennessee Health Science Center, Memphis, and the Sleep Disorders Center, Memphis Veterans Administration Medical Center, Memphis, Tennessee.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Sultan-Ali
mesh_terms: D015992:Body Mass Index; D000066491:Clinical Decision-Making; D005260:Female; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D017286:Polysomnography / Q000379:methods*; D012189:Retrospective Studies; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis*; D013714:Tennessee