Mayo Clinic Center for Sleep Medicine, Mayo Clinic, Rochester, Minnesota.
Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota.
J Clin Sleep Med. 2018 Apr 15;14(4):631-639. doi: 10.5664/jcsm.7060.
Health care complexity includes dimensions of patient comorbidity and the level of services needed to meet patient demands. Home sleep apnea tests (HSAT) are increasingly used to test medically uncomplicated patients suspected of having moderate to severe obstructive sleep apnea (OSA). Patients with significant comorbidities or other sleep disorders are not candidates for HSAT and require attended in-center polysomnography. We hypothesized that this trend would result in increasingly complex patients being studied in sleep centers.
Our study had two parts. To ascertain trends in sleep patient comorbidity, we used administrative diagnostic codes from patients undergoing polysomnography at the Mayo Clinic Center for Sleep Medicine from 2005 to June 2015 to calculate the Charlson and the Elixhauser comorbidity indices. We measured the level of services provided in two ways: (1) in a subset of patients from the past 2 months of 2015, we evaluated correlation of these morbidity indices with an internally developed Polysomnogram Clinical Index (PSGCI) rating anticipated patient care needs from 0 to 3 and (2) we measured the sleep study complexity based on polysomnography protocol design.
In 43,780 patients studied from 2005 to June 2015, the Charlson index increased from a mean of 1.38 to 1.88 (3.1% per year, < .001) and the mean Elixhauser index increased from 2.61 to 3.35 (2.5% per year, < .001). Both comorbidity indices were significantly higher at the highest (Level 3) level of the PSGCI ( < .001), and sleep study complexity increased over time.
The complexity of patients undergoing attended polysomnography has increased by 28% to 36% over the past decade as measured by validated comorbidity indices, and these indices correlate with the complexity of rendered care during polysomnography. These findings have implications for increasing requirements for staffing, monitoring capabilities, and facility design of future sleep centers.
A commentary on this article appears in this issue on page 499.
医疗保健的复杂性包括患者合并症的维度和满足患者需求所需的服务水平。家庭睡眠呼吸暂停测试（HSAT）越来越多地用于测试患有中度至重度阻塞性睡眠呼吸暂停（OSA）但无医学并发症的疑似患者。患有严重合并症或其他睡眠障碍的患者不适合进行 HSAT，需要进行有监督的中心多导睡眠图检查。我们假设，这种趋势将导致越来越多的复杂患者在睡眠中心接受研究。
我们的研究有两个部分。为了确定睡眠患者合并症的趋势，我们使用 2005 年至 2015 年 6 月期间在梅奥诊所睡眠医学中心进行多导睡眠图检查的患者的行政诊断代码来计算 Charlson 和 Elixhauser 合并症指数。我们通过两种方式衡量提供的服务水平：（1）在 2015 年过去两个月的患者子集中，我们评估这些发病率指数与内部开发的多导睡眠图临床指数（PSGCI）之间的相关性，该指数预计从 0 到 3 不等的患者护理需求；（2）我们根据多导睡眠图协议设计来衡量睡眠研究的复杂性。
在 2005 年至 2015 年 6 月期间研究的 43780 名患者中，Charlson 指数从 1.38 增加到 1.88（每年增加 3.1%，<0.001），Elixhauser 指数从 2.61 增加到 3.35（每年增加 2.5%，<0.001）。这两个发病率指数在 PSGCI 的最高（第 3 级）水平上显著更高（<0.001），并且睡眠研究的复杂性随着时间的推移而增加。
过去十年中，通过经过验证的合并症指数衡量，接受有监督的多导睡眠图检查的患者的复杂性增加了 28%至 36%，并且这些指数与多导睡眠图期间提供的护理复杂性相关。这些发现对未来睡眠中心的人员配备、监测能力和设施设计的要求不断提高产生了影响。
本文的评论见本期第 499 页。
