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Home Sleep Studies vs. In-Lab
I understand a study has been published in the August issue of Chest concluding that diagnosis and titration at home with portable equipment is as effective as in-lab studies. If someone has a subscription, maybe they want to comment further.
"After 4 weeks, there was no significant difference between the two groups in regard to any sleep measures or CPAP compliance. Researchers conclude that select subjects with suspected OSA could be diagnosed and treated at home"
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Replies to This Discussion
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Permalink Reply by Henning on
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"Home Test" and "Home Test" is many things.
Here in Denmark we perform a full PSG study as a home test. The reason for this is that to sleep in your own bed gives a better outcome of your sleep. We also have other home tests specially dedicated OSA.
We have of course also in-lab PSG, but this is usually reserved for special cases.
I've tried in-lab PSG, home PSG and a home OSA testing. In my case there was no difference, since I only had OSA.
From an economic standpoint, can be tested and treated far more patients using home tests.
As for UARS is Home Tests often better to detect this, particularly systems used by dentists.
Henning
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Permalink Reply by SleepMBA on
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Good questions Banyon. I'll answer by giving some examples.
Heart Arrhythmias:
Recently, I had a patient who came in with a history of OSA. This person has been on xPAP for years and needed a retitration. For the entire study, the patient exhibited PVC's and PAC's (premature heartbeats) and frequent Bigeminy...concerning to say the least. No where in his chart or history and physical did it say he had any heart problems. Upon awakening, I asked him a few questions regarding his medical history. As far as he knew, his heart was fine and has never had a doctor mention it. For somebody like this, our sleep lab doc (a Neurologist) will refer him to a cardiologist. This probably could be detected at a GP's office, but never was i guess.
Irregular Brain Waves: With the EEG portion of the hook up, we can detect seizure activity. I've performed some sleep studies where we add a few more EEG leads looking for such activity. But, we can pick up seizure activity with the standard hook up. Personally, I haven't recorded a seizure. My point here is, many of the people that I've performed regular sleep studies and expanded EEG studies have never had been screened for seizure activity before. If there is any sort of irregular brain activity, that patient would be refered to a specialist or undergo a formal EEG or MRI.
Movement Disorders: Just the camera recording all night itself has helped out many people. One person I observed had a movement disorder only involving their arm. Another disorder where the camera comes into play is REM behavior disorder.
Banyon said:SleepMBA said, “Personally, I have found on some patients heart arrhythmias, irregular brain waves in certain channels, and observed certain movement disorders, all this wouldn't have been picked up on a home test. You get a lot more bang for the buck in a sleep center.”
Like Rooster, I also have a great interest in economics so “more bang for the buck” grabs my attention. Tell me some more about where the additional bang is reaped.
- If you find a heart arrythymia, what is done about it? Could the same arrythmia not be found by a nurse in a GP’s office?
- If you find irregular brain waves, what is done about it? Could these not be detected by a nurse in a GP's office?
- If you find movement disorders, what is done? Can these disorders be properly diagnosed in one night’s PSG?
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Permalink Reply by RockRpsgt on
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great response MBA. I have recorded seizures during a sleep study. The pt came in complaining of violent dreams and headaches. The study showed micro-seizures during sleep. When we went in to check on the pt he described some very detailed dreams. I have also caught slow moving brain waves (theta, delta waves) while the pt was awake. during this time the brain waves should be very fast. This particualr pt had a brain tumor that had to be removed. the study most likely save this pt's life. Neither of these would have been caught in a docs office or by a home study.
SleepMBA said:Good questions Banyon. I'll answer by giving some examples.
Heart Arrhythmias:
Recently, I had a patient who came in with a history of OSA. This person has been on xPAP for years and needed a retitration. For the entire study, the patient exhibited PVC's and PAC's (premature heartbeats) and frequent Bigeminy...concerning to say the least. No where in his chart or history and physical did it say he had any heart problems. Upon awakening, I asked him a few questions regarding his medical history. As far as he knew, his heart was fine and has never had a doctor mention it. For somebody like this, our sleep lab doc (a Neurologist) will refer him to a cardiologist. This probably could be detected at a GP's office, but never was i guess.
Irregular Brain Waves: With the EEG portion of the hook up, we can detect seizure activity. I've performed some sleep studies where we add a few more EEG leads looking for such activity. But, we can pick up seizure activity with the standard hook up. Personally, I haven't recorded a seizure. My point here is, many of the people that I've performed regular sleep studies and expanded EEG studies have never had been screened for seizure activity before. If there is any sort of irregular brain activity, that patient would be refered to a specialist or undergo a formal EEG or MRI.
Movement Disorders: Just the camera recording all night itself has helped out many people. One person I observed had a movement disorder only involving their arm. Another disorder where the camera comes into play is REM behavior disorder.
Banyon said:SleepMBA said, “Personally, I have found on some patients heart arrhythmias, irregular brain waves in certain channels, and observed certain movement disorders, all this wouldn't have been picked up on a home test. You get a lot more bang for the buck in a sleep center.”
Like Rooster, I also have a great interest in economics so “more bang for the buck” grabs my attention. Tell me some more about where the additional bang is reaped.
- If you find a heart arrythymia, what is done about it? Could the same arrythmia not be found by a nurse in a GP’s office?
- If you find irregular brain waves, what is done about it? Could these not be detected by a nurse in a GP's office?
- If you find movement disorders, what is done? Can these disorders be properly diagnosed in one night’s PSG?
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Permalink Reply by D. W. Conn on
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I have seen to much go so very wrong with what little at home testing I have been involved with... I NO cut in stone.
I would not object to an RPSGT going into someones home and performing a full polysomnogram but that is not cost effective.
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tell them about the restrictions to home testing in texas Conn! if you have a complaint of insomnia, parasomnia, or cardiac problems insurance does not have to reimburse. also in some states if you have inconclusive results via an HST you lose the right to the in lab PSG. make sure you read the fine print.
D. W. Conn said:I have seen to much go so very wrong with what little at home testing I have been involved with... I NO cut in stone.
I would not object to an RPSGT going into someones home and performing a full polysomnogram but that is not cost effective.
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Why is it not cost effective? the Alice software can be used remotely from a van. it would not be to hard to set up a mobile PSG. Sleep logistics out of Vegas is doing very well with it.
D. W. Conn said:I have seen to much go so very wrong with what little at home testing I have been involved with... I NO cut in stone.
I would not object to an RPSGT going into someones home and performing a full polysomnogram but that is not cost effective.
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1 polysmonogram vs 2 polysmonogram. I would not want to pay a tech full price for conducting just one test when its better to do two.(unless a pedi than always 1 on 1)
Rock Hinkle said:Why is it not cost effective? the Alice software can be used remotely from a van. it would not be to hard to set up a mobile PSG. Sleep logistics out of Vegas is doing very well with it.
D. W. Conn said:I have seen to much go so very wrong with what little at home testing I have been involved with... I NO cut in stone.
I would not object to an RPSGT going into someones home and performing a full polysomnogram but that is not cost effective.
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It is the people in the pew (insurance companies) that are pushing the home study. i would and have chosen the HST for myself. I have also done the PSG several times. personally I would not choose the HST for my children. if you are going to hook up a child do it right. you may only get one chance.
Rooster said:You just invented two implications.
Do you want to debate about the success and practicality of socialized medicine?
As far as "Rooster ruling", I have no desire to make economic and health care decisions for anyone (other than myself and my children). I very much want to leave those decisions to individual patients and individuals choosing to provide health care.
It is the people in the opposite pew who want to decide in a central planning way, who does what to whom and who pays what and who receives what monetary compensation. It is this type of system that has already driven medical care costs so high.
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how did your breadmaker lose his CDL due to an Apnea related incident? the only way that i have heard that someone can lose a CDL due to apnea is noncompliance. if you have diagnosed untreated apnea you should not be driving.
Amy OHare said:"Never mind economics and cost?" < How can you say such a thing to a family that's struggling to get by and the bread maker has just lost his/her CDL license due to a sleep apnea related issue? That family has to get their license back but cannot afford thousands from a lab-based test, The only other option they have is a home-based test, which is close to 75% less expensive. Economics and cost need to be considered, they always are for me. It's one thing to advocate for lab-tests and another to debase sleep-based home test just because they are not the "gold standard".
99 said:never mind economics and costs
which one would you go for, for yourself and your family
Rooster said:You just invented two implications.
Do you want to debate about the success and practicality of socialized medicine?
As far as "Rooster ruling", I have no desire to make economic and health care decisions for anyone (other than myself and my children). I very much want to leave those decisions to individual patients and individuals choosing to provide health care.
It is the people in the opposite pew who want to decide in a central planning way, who does what to whom and who pays what and who receives what monetary compensation. It is this type of system that has already driven medical care costs so high.
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Permalink Reply by Rooster on
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I have seen this so many times. It is actually part of what my consulting firm does. We go into companies in industries where the technology and/or the market is changing (that is nearly all companies these days). We find successful people in these companies. They became successful doing things a certain way. Now something is changing and all they can see is why the new way will not be successful. They want to keep doing things the same way they have been doing them.
These are usually very competent people. This is just human nature. Competent people want to keep doing that which made them successful despite change looming over them. It is actually easier to convince incompetent people to get on board with the new program.
Home sleep studies are hitting the market at an accelerating pace. My own sleep doctor, who has two sleep labs thirty miles apart, has started using them and will use them more and more. Home sleep studies are a reality that won't go away. People who cannot afford an in-labber or are repulsed by the idea of sleeping in a lab will jump on them first and then they will spread rapidly to other patient segments.
Economics matters greatly. Paying attention to economics will improve medical care.
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Permalink Reply by 99 on
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i agree with the last couple of statement by JNK and Rooster
I have seen this so many times. It is actually part of what my consulting firm does. We go into companies in industries where the technology and/or the market is changing (that is nearly all companies these days). We find successful people in these companies. They became successful doing things a certain way. Now something is changing and all they can see is why the new way will not be successful. They want to keep doing things the same way they have been doing them.
These are usually very competent people. This is just human nature. Competent people want to keep doing that which made them successful despite change looming over them. It is actually easier to convince incompetent people to get on board with the new program.
Home sleep studies are hitting the market at an accelerating pace. My own sleep doctor, who has two sleep labs thirty miles apart, has started using them and will use them more and more. Home sleep studies are a reality that won't go away. People who cannot afford an in-labber or are repulsed by the idea of sleeping in a lab will jump on them first and then they will spread rapidly to other patient segments.
Economics matters greatly. Paying attention to economics will improve medical care.
I agree completely that in the future it will become that much harder for poor people who need in-lab testing to get it, since insurance will insist on substandard home sleep tests for economic reasons.
Some in the industry may choose to rejoice at that development. But in my opinion, those who care most and deepest about the needs of patients will mourn that many who should have an in-lab PSG will not be able to get one for financial reasons.
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Permalink Reply by Judy on
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No, Banyon, heart arrythmias all to often can NOT be found by the NP in the doctor's office!!!! I am a prime example. 5 times between 07 Mar 10 and 22 Jul 10 I experienced strong, erratic heartbeats of various lengths of time. Seeming to get longer each time. On 23 July 10 they continued for so long and w/some chest pain and LOTs of SOB that I ended up calling 911 and being transported to ER. I upped my 02 to 4L instead of the prescribed 2L and sat quietly waitng for them and staying on the phone w/911. The PMs spent around 1/2 hour here on arrival, starting an IV, getting some aspirin down me, running an EKC strip, etc. before transporting me. It was another 1/2 hour drive to the hospital. When I arrived at the hospital my HB was still erratic and strong though GREATLY REDUCED at 100-160 BPM. It had been beating from a low of 54 to a high of 247 according to my Nonin Onyx finger oximeter prior to and when I called 911.
An EKC in the doctor's office is generally a less than 5 minute strip. If these arrhythmias only happen occasionally unless they should happen to occur during an office visit and an EKG strip being run they would NOT be detected. My family doctor ordered a 30 day Event Monitor. I wasn't too impressed w/the idea since they occurred so seldom. I got lucky tho (I guess) as I did have ONE episode of STRONG, ERRATIC HBs the second day w/the Event Monitor. I received a call immediately from the monitor company and they had me transmit over the phone meanwhile notifying a local cardiologist who then called me, talked to me and urged me to go to ER. As it turned out this episode wasn't lasting anywhere near so long as the previous episode on the 23rd, and I had already taken aspirin and put my 02 on 4L and was sitting quietly my HBs were quickly fading and slowing. Given the embarrassment of calling 911 and being transported and released just a few days before I declined. I have NOT had an episode since. At least not a NOTICEABLE episode. The Event Monitor HAS picked up some mild arrhythmia I'm not even aware of from time to time. They always occur when I am stting quietly at the 'puter, watching TV, sleeping, etc.
There is no GP's office I know of that even has EEG capabilities in their office. And even so EEGs are no where near so easy to administer.
Banyon said:SleepMBA said, “Personally, I have found on some patients heart arrhythmias, irregular brain waves in certain channels, and observed certain movement disorders, all this wouldn't have been picked up on a home test. You get a lot more bang for the buck in a sleep center.”
Like Rooster, I also have a great interest in economics so “more bang for the buck” grabs my attention. Tell me some more about where the additional bang is reaped.
- If you find a heart arrythymia, what is done about it? Could the same arrythmia not be found by a nurse in a GP’s office?
- If you find irregular brain waves, what is done about it? Could these not be detected by a nurse in a GP's office?
- If you find movement disorders, what is done? Can these disorders be properly diagnosed in one night’s PSG?
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