"please keep me updated about oximeters "
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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 Mark Douglas on
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Judy,
I apologize in advance for not knowing all (okay any) of the nomenclature for this topic. I just want to say I was reading an article in the doctor's office about a new method of diagnosing arrhythmias from an EEG that is much more accurate. It was some mathematical calculation that allowed a dramatic improvement, because the patient does not have to be in arrhythmia , to diagnose the likelyhood of having one in the future. Apparently there are enough tell -tale signs, and a doctor does not have to sift through hours of heart monitor readings. This "algorithm" was very good at dectecting who would have them.
I wish I could tell you the magazine, or more about it. But the bottom line, there has been a recent improvement.
I read it because I had been introduced to the wonderful world of arrhythmias after my bypass surgery---when my heart went to 250 and caused a bunch of nurses to intervene, and call the surgeon at 2am. Fortunately I never had a repeat.
I assume they use this improvement to know which patients to medicate, to prevent the arrhythmias. I had to take the medicine for a while, but got off it. Knock on wood.
Judy said: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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Permalink Reply by Judy on
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No need to apologize. None of us were born knowning what the various "initials" stand for. I know that EEG stands for electroencepalogram which is a study of the electrical brain waves. At least I THINK I know that.
What I do get confused about is an ECG vs an EKG or are they the same thing? Echocardiogram is, I believe, actually an ultrasound of the heart. An electrocardiogram, I think, is when they place leads on your chest and ribs and get squiggly line graphs checking the electrical activity of your heart. So which set of initials is which set of initials? Or what do these two sets of initials stand for?
There! NOW you can be corn-fused w/no need for an apology for sure!!!
As far as the articles on the success of the home sleep tests - have you actually read the entire articles? Did you make note of the extreme education patients were given BEFORE being given the home sleep test in each of these articles??? Hell, if patients got that same education after their in-lab studies and BEFORE being given their PAP equipment can you even imagine how much higher the successful compliance rate would be for the in-lab studies as well? EDUCATION is the key and patients all to often are NOT getting that education - except in forums such as this and all too often too late after receiving and accepting inferior equipment because they hadn't been educated before hand.
And, yeah, if a patient is provided w/a compliance data capable only CPAP, that patient is being provided w/INFERIOR equipment. I don't care if that bare bone entry level CPAP can provide the same pressure as a fully data capable one. If it isn't capable of providing Leak, AHI and AI data it is an inferior device!!!!! It can provide NO ASSISTANCE in detecting what the problems the patient may be having w/acclimating to CPAP therapy.
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Permalink Reply by Mary Z on
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An at home study is preferable to no study, IMHO. Of course it goes without saying the guidelines for home testing should be followed.
Using the EEG to diagnose cardiac arrythmias is a novel idea, and impressive if it truly works well. I don't know of any GP, or cardiologist that has EEG capabilities in the office. A Neurologist should be able to do the test as long as it doesn't look for something outside the normal parameters of EEG testing. I might take a cardiologist to order what specifically to look for. As these arrythmias can be few and far between, though scary and possibly life threatening, I hope this technology becomes more readily available soon.
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Wow JNK --- I am impressed! That's not the exact artlcle I read, but its about the very same thing-- I think anyway. The article I read was in a magazine the Methodist hospital put out, and was much more for the non-professional. I remember it was Australia related-- like the one you found. Plus, it reported this new method increased the accuracy of diagnosis from the present 80, to 95%, and it required drastically less time to interpret.
j n k said:Mark,
You may have had something like this in mind?:
http://espace.library.uq.edu.au/eserv/UQ:9931/n37.pdf
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Permalink Reply by Banyon on
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Despite having what the heart doc called a benign arrythmia, I don't know much about them. Is it correct that from Judy's post I could conclude that an "Event Monitor" is a much more practical and inexpensive way, as compared to a PSG, to cover more people, particularly the "poor", and get arrythmias diagnosed and treated?
Is it also safe to conclude from Mark's nice post that new ways of analyzing ECGs will be even more inexpensive and accurate than PSGs for the purpose of diagnosing arrythmias?
jnk said, "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."
Is it also safe to conclude that jnk's heart bleeds so emotionally for the "poor", that his emotions leave him unable to rationally construct ideas that consider economics and sociology and actually help the "poor" instead of having pity on them and doing more damage to the "poor"? :)
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Unfortunately heart-felt sympathy for the poor has a long history of hurting the poor. You get the opposite of what you say you want.
What is known to help the poor the most is not providing them security, but providing them their individual rights.
In the last 100 years, the countries that increased the standards of living the most and saw the most people move out of poverty, were those countries whose governments protected the rights of all their citizens to conduct their lives as they saw fit. The tremendous progress these countries made was in spite of their welfare programs, not due to their welfare programs.
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Permalink Reply by 99 on
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you will alway have the poor with you
fine sentiments banyond
in the real world governments want to cut do wn on cost which is fine by me, but then award themself pay rises out of ithe monies saved and then claim we have no extra money for these things, which is true, because of their greed, an only give out the slops saying how good we are
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99 said, "in the real world governments want to cut do wn on cost"
Absolutely not true in the U.S.
Our politicians want to spend more and more and make the government bigger and bigger.
Every administration, Republican or Democrat, has grown the Federal budget and the number of government employees.
Where do you get the idea that government wants to cut costs?
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Let me add that free markets and individual freedom are the engines of economic development.
Economic development is what lifts the poor out of poverty and pays for medical care.
Misguided sentiments of people who believe in government welfare and redistribution of wealth hurt the poor very much.
The "rich" learn to work with such systems and the poor become poorer.
You guys need to read some political, social and economic history in between visiting forums. Then you could do a good thing for the poor when you go to the ballot box.
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My first thought was to reply, "Yes".
However, we know there is a significant problem in the U.S. with doctors ordering unnecessary tests. Don't we?
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jeff, I don't know if you mean to, but you come off as being against all home testing. I think that it's appropriate in many circumstances- there are guidelines (which like ALL guidelines are subject to interpretation and physian/patient bias). Like someone said in this thread earlier- good education regarding the test and about sleep apnea is so important. If we are not educated consumers who can stand up for ourselves and follow up with treatment and the doctor- I don't think it matters what kind of test you have.
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I think the discussion has gone full circle.
Home sleep studies will grow in importance, not because of the heavily-regulated, government-protected insurance industry favoring them, but because they are effective and more economical that in-lab PSGs. Home sleep studies will allow our society to perform more sleep studies and get more diagnoses.
If you tell me there are some patients for whom an in-lab PSG is necessary for proper diagnosis, I would agree that is a decision between the patient and his doctor.
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