IMPROVING PATIENT SAFETY AND THE EVALUATION OF DISORDERS OF HYPERSOMNOLENCE IN THE SLEEP LAB

Abstract

Improved understanding of the complex physiology that underlies sleep disorders and new technologies applied to the field of sleep medicine require a re-calibration of patient care standards and new approaches to meeting patient needs. An in-lab sleep study is a common, non-invasive procedure that is widely considered very safe. The existing literature about patient safety events and risks associated with an in-lab overnight sleep study are 10-20 years old. However, new home-based sleep technologies appropriate for many healthy individuals (“home sleep tests”), result in selection of increasingly medically complex patients referred to a sleep lab for an in-lab assessment. Comorbid cardiac, pulmonary, and neurologic conditions are indications for in-lab, rather than home sleep testing, and sleep lab safety protocols that can be applied by sleep technicians without a medical background must meet the needs of these increasingly medically complex patients. Here, we describe the frequency of patient safety events in our sleep lab over three years, 9,558 studies. In addition to maintaining high standard for patient safety in the sleep lab, increased scrutiny of existing sleep testing is needed to understand their utility for diagnosis of rare or complex sleep disorders. While the multiple sleep latency test for the evaluation of excessive daytime sleepiness has been the standard diagnostic tool for evaluation of narcolepsy and is broadly used clinically, there is an increasing body of literature suggesting that it is limited for evaluating all patients with excessive daytime sleepiness. Here, we characterize this standard test’s limitation in a cohort of patients (n=42) with prolonged sleep duration. Together, this work aims to define the frequency and characteristics of patient safety events in the sleep lab and describe limitations of specialized testing in a subpopulation of patients with excessive sleepiness, as a foundation to build appropriate or alternative protocols to optimize patient care and evaluation in an increasingly complex field.