The Impact of Sleep Diagnostic Testing Completion Utilizing Patient Portal Messaging

Abstract

Background: Patients with neuromuscular disease (NMD) often develop OSA with hypoventilation requiring positive pressure support while sleeping. Home nocturnal oximetry (noc ox) and in-lab sleep studies provide critical information to determine the need for support. Failure to identify these conditions can lead to serious consequences such as increased morbidity, mortality risk, and poor quality of life. Adherence to sleep studies have shown to be poor in those with suspected OSA. We hypothesize that adherence may be better achieved by employing the RT case manager to send a reminder message via the patient portal after their clinic visit.

Methods: A retrospective chart analysis of 393 patients from the University of California, Davis multidisciplinary PM&R clinic with NMD and who clinically required a noc ox or an in-lab sleep study. Of the 396 patients, 200 of them were in the usual care group (average age 38 y, 128 (64%) males) and were referred for a diagnostic sleep assessment between 2015 and 2020. They received no notification after the clinic visit regarding their referral. The intervention group was made up of 193 patients referred between 2021 and 2023 (average age 40 y, 122 (63%) males). These patients received a reminder message from their RT case manager in their patient portal 2-3 weeks after clinic visit. The days to completion of the noc ox and in-lab sleep studies were monitored for the intervention group. Analysis of data was performed using descriptive statistics and chi-square test when appropriate.

Results: Referrals for noc ox tests were placed for 114 (57%) patients in the usual care group and 115 (60%) in the intervention group. Of the referrals, 31 (27%) were completed in the usual care group and 74 (64%) in the intervention group (P < .001). Referrals for in-lab sleep studies were placed for 86 (43%) for the usual care group and 78 (40%) in the intervention group. Of these referrals, 38 (44%) were completed in the usual care group and 25 (32%) in the intervention group (P = .91). Mean days to completion for the noc ox referrals were 33.6 ± 3.96 and 68.2 ± 7.65 for the sleep study group.

Conclusions: Providing reminders with to NMD patients via their patient portal significantly improved adherence for noc ox testing but not for sleep studies. The days to completion for these tests between 2021 and 2023 were shorter for noc ox testing compared to sleep studies, respectfully. Continued efforts to improve adherence to sleep study completion for NMD patients is necessary.