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A feasibility study assessing home video telemetry polysomnography (HVTP) as a diagnostic procedure for adult patients undergoing investigation for parasomnias

Student thesis: Doctoral Thesis

Background: The techniques used in assessing sleep disorders must endeavour to accurately document behavioural and physiological sleep features that they are designed to record, be acceptable to the patients and be economically viable. Present practice for laboratory based polysomnography, which is the gold standard for assessing sleep disorders, falls short of these expectations. Home recordings might help to obtain a more natural sleep, be less costly and preferable to patients. However, the feasibility of comprehensive home sleep studies is unclear due to the complexity of recording synchronised neurophysiological, cardiorespiratory and audio-visual signals in an unsupervised and non-dedicated environment. The purpose of this study was to explore whether home video telemetry polysomnography can be performed successfully in people’s own homes among patients referred to King’s College Hospital telemetry unit to be investigated for parasomnias.
Method: A mixed method with two quantitative strands and one qualitative strand was adopted to assess data quality, cost aspects and acceptability. The three strands of this convergent parallel design were used to measure related but different facets of the study. A thirty-channel recording of physiological signals was synchronised with audio-visual signal. A numerical score point quality grading system developed by the researcher to assess sufficiency and readability of the recorded data was used. One on one semi-structured interview was used for the qualitative strand. Process based costing was used to asses cost viability.
Results: Twenty-one patients underwent two nights of the sleep study. The findings show that data was sufficient for sleep analysis in 97.6% of the nights recorded. The analysis shows that neurophysiological signals for sleep staging and for extended montage were readable or required minor adjustment in 95.1% of the studies. Cardiorespiratory signals were readable or required minor adjustments in 97.6% for electrocardiogram and 85.4%for respiratory signals. Video picture and contents were recognisable in 95.1%, and audio signal was present, audible and clear in 80.5%.The procedure was acceptable to patients with burden of parasomnia, home environment related benefits and financial considerations emerging as main drivers for acceptance. The average cost was £617.15 compared to the standard average tariff of£998.49 for similar procedures within our hospital setting representing a saving of 38.2%.
Conclusion: The present feasibility study indicates that Home Video Telemetry Polysomnography is technically feasible, acceptable to the patients, and is economically viable.
Original languageEnglish
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Award dateMay 2017
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