Business in Sleep Medicine

We applaud Quan and Epstein for their candid editorial regarding the abrupt dissolution of the massive Sleep Health Centers (SHC) operation. Indeed a perfect storm combination of factors contributed to the SHC demise. This is a critical time to take stock in what sleep specialists offer, but not lose sight of several key issues surrounding care models specifically for patients with sleep apnea.

First, it is commonly assumed that out-of-center testing is cost-effective simply because it costs less than laboratory polysomnography (PSG) to implement a single night of testing. As pointed out in a recent pro-con debate in this journal, this arguably myopic cost assumption has been questioned: quantitative cost-benefit analyses show that the out of center model is not clearly more cost-effective,3–6 and may even be more expensive,7 compared with the traditional (inpatient) testing model. This should come as no surprise for several reasons. One is that the testing phase for sleep disordered breathing is only a fraction of the expense related to the chronic management costs. Moreover, as pointed out by the AASM 2007 guidelines,8 the modest sensitivity and specificity of home testing devices renders them inappropriate for all but the highest echelon of risk (specifically, 80% pre-test probability of at least moderate OSA).


  • • The massive Sleep Health Centers
  • • Single night of testing
  • • Patients with sleep apnea
  • • Highest echelon of risk

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