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Blog Feature

By: Kevin Asp on November 18th, 2015

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Are Split Night Studies Cost Effective?

Sleep Technologist Advice

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When are split night studies a good alternative for your patient?

As more patients are being diagnosed and treated for sleep apnea, the increasing demand for treatment options has made split night studies a viable option for patients with sleep disorders who do not want to go through a standard full night study. 

Split-night sleep studies involve diagnostic polysomnography during the first portion of the night followed by CPAP titration for the remainder of the night. This approach has been used to diagnose sleep apnea and titrate CPAP during a single night and can reduce costs. 

Are split night studies cost effective?

Split night studies have become less expensive testing alternatives for obstructive sleep apnea, and for awhile their impact on cost effectiveness of the overall evaluation and treatment has been unknown.
There have been studies that attempted to address the issue such as:
McArdle's study reported that there was no difference in long term CPAP use, median nightly CPAP use, post-treatment Epworth scores, and the frequency of clinic visits in patients managed with split-night sleep studies compared to patients managed with standard full-night polysomnography. Median time from referral to treatment was less for the split-night patients than for full-night patients.
Another study by the Journal of Clinical Sleep Medicine, in which researchers compared the cost effectiveness of a full night study and a split night study over a five-year period, found that split night studies were just as effective as full night studies, while being cheaper than the full night study approach. 
However, the debate of cost effectiveness and treatment efficacy of split night studies and full night studies is still ongoing and are subject to interpretation.

The need for more clinical trials 

In an article titled "More Isn’t Always Better: Cost-Effectiveness Analysis and the Case for Using a Split-Night Protocol" several sleep physicians responded to the study mentioned above by stating that more clinical trials are needed to make proper determinations on cost effectiveness and treatment effectiveness. 
The authors argued that not only does the sleep community have a shared responsibility to provide proper treatment recommendations to patients, but also an obligation to use shared resources wisely. 
The authors raised skepticism to whether the study provided a comprehensive unbiased analysis on split night studies as a treatment option that offers benefits similar to a full night study at a lower cost.
The authors of the article also noted the following:
"We should not wait for outside parties to tell us how to use resources wisely. We need to ignore personal economic incentives and utilize a strategy that saves money and reduces patient inconvenience and time to effective treatment by potentially eliminating the need for a second study night."

Considerations for sleep technologists

Despite the promising advantages of split-night PSG, there are concerns about using split-night studies as the preferred approach. One concern is the individual variability in the sleep pattern. Another concern is accurate assessment of the sleep architecture. Some patients demonstrate sleep disordered breathing only during REM sleep; a split-night study may have inadequate time for proper titration in these patients.
In essence, sleep medicine professionals should keep in mind that there are patients who qualify for a split night study, but cannot be adequately treated without a full night's worth of titration study.
The split night study vs. full night study debate is a debate worth having in your sleep center. 
If you're interested in learning more about the pros and cons of split night studies, read the AAST's Case of the Month (a thorough analysis of sleep medicine topics) on split night studies here and here. And remember that Case of the Month articles are free for AAST member and also award 1 CEC credit per article.
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About Kevin Asp

Because of the implementation of his best practices of Implementing Inbound Marketing in its Medical Practice, he turned the once stagnant online presence of Alaska Sleep Clinic to that of "The Most Trafficked Sleep Center Website in the World" in just 18 months time.

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