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do snorers need sleep test to diagnose OSA?
following study used as evidence for need to do sleep study on so-called "simple snorers" to diagnose OSA. i think it suggests just the opposite. what do you guys think?
Views: 193
Replies to This Discussion
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Permalink Reply by RockRpsgt on
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Without the sleep study 2% of the pt's would have been put on PAP without needing it. Another 2% would have received the wrong Dx. These 4 people would have had to suffer through uneeded or the wrong treatment so that the other 27 could have skipped out on one night in a lab. All in all without the study many things could have been missed such as arrythmias, PLMS, sleepwalking, and seizures. The out of pocket spending would have been around the same for all.
It is not the study that needs to change. Mike you have endured only a few studies that in the end completely changed your life. 2 days of your long life was all it took. I have been able to save or extend the lives of many through these studies. If you want to bad mouth the techs, doctors, or DMEs go ahead. The study is the one for sure thing that works.
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Permalink Reply by Mike on
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i have no doubt you save lives by doing the full PSG. and i'm grateful for it. i just don't think it's realistic to expect the masses to run in for full PSGs. Why? Because they haven't. Only 15% of those with OSA are diagnosed. So on balance, I wonder whether more lives would be saved by skipping the study and putting those who snore directly on CPAP.
Rock Hinkle said:Without the sleep study 2% of the pt's would have been put on PAP without needing it. Another 2% would have received the wrong Dx. These 4 people would have had to suffer through uneeded or the wrong treatment so that the other 27 could have skipped out on one night in a lab. All in all without the study many things could have been missed such as arrythmias, PLMS, sleepwalking, and seizures. The out of pocket spending would have been around the same for all.
It is not the study that needs to change. Mike you have endured only a few studies that in the end completely changed your life. 2 days of your long life was all it took. I have been able to save or extend the lives of many through these studies. If you want to bad mouth the techs, doctors, or DMEs go ahead. The study is the one for sure thing that works.
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What about the titration? Are the masses supposed to be auto-titrate as well? Your still missing the point on how difficult it is to convince someone that they need CPAP. We are not losing patients because of the overnight study. We are losing them because they won't listen. That is not going to change by doing away with the study with or without the prescription. We have talked about this Mike it is not easy to get people to listen. With the exception of a few labs, Docs, techs, and DMEs the PSG and titration are the best things sleep has going for it.
What about the 4 to 20% of pts that will be diagnosed wrong? Why is it not alright for the current system to leave people behind, but ok for the one that you suggest to do so? The problem with the current system is that not everyone is getting the correct, or the same treatment. How will deregulation of the system fix this. We can't go from one broken system to another. The only problem with the study is the price. If a person can't sacrifice one night for their health or family then their issues are more of priority then health.
I know that we hear about false negatives on SG all of the time. I have talked to hundreds of techs and we are just not seeing the numbers that are being suggested, posted, and published.
Mike said:i have no doubt you save lives by doing the full PSG. and i'm grateful for it. i just don't think it's realistic to expect the masses to run in for full PSGs. Why? Because they haven't. Only 15% of those with OSA are diagnosed. So on balance, I wonder whether more lives would be saved by skipping the study and putting those who snore directly on CPAP.
Rock Hinkle said:Without the sleep study 2% of the pt's would have been put on PAP without needing it. Another 2% would have received the wrong Dx. These 4 people would have had to suffer through uneeded or the wrong treatment so that the other 27 could have skipped out on one night in a lab. All in all without the study many things could have been missed such as arrythmias, PLMS, sleepwalking, and seizures. The out of pocket spending would have been around the same for all.
It is not the study that needs to change. Mike you have endured only a few studies that in the end completely changed your life. 2 days of your long life was all it took. I have been able to save or extend the lives of many through these studies. If you want to bad mouth the techs, doctors, or DMEs go ahead. The study is the one for sure thing that works.
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Permalink Reply by Rooster on
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Home studies will get cheaper - that is the way to go.
"Missing arrythmias, PLMS, sleepwalking, and seizures" is just fear tactics by the sleep lab industry to keep the money flowing their way. These are rare cases and in any case, sleepwalking can be diagnosed by the patient and his family and if educated they can also diagnose PLMS. Arrhythmias may go away with proper CPAP treatment. Seizures are rare and may also go away with proper CPAP treatment.
Does anyone want to hear the sleep-lab industry tell us they are greatly concerned about our health and we need a lab study? Don't forget these are the people who still today object to patients having a machine with software to monitor the effectiveness of their therapy!!! This industry prefers control of their patients over good therapy and wants the money to keep flowing with no questions asked.
This is common in any market, medical or others, the entrenched players don't want change. They don't want to see new methods and technology. They don't want to see prices fall. They have skills and methods of working which made them financially successful and they fear having to develop new ways of being financially successful.
BTW, I consider snoring to be an unhealthy condition of sleep-disordered breathing that requires treatment for optimal health. It even has a bad effect on the health of the bed partner:
The Overlooked Effects of “Second-Hand” Snoring
April 11th, 2010 by dlawler
This patient talks candidly about the often overlooked effects of “second-hand” snoring. Just like cigarette smoking damages the health of those near by, snoring has a significant detrimental effect on the sleep of the non-snoring bed partner. It is also interesting to hear his comments about feeling good before wearing the oral appliance. It is very common to have someone say that they feel good prior to having their sleep-breathing disorder managed and then be very surprised when they feel so much better afterwards.
http://www.centerforsoundsleep.com/blog/
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Home testing will accelerate rapidly in 2011 --> http://www.sleepguide.com/forum/topics/watchpat-spearheads
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Permalink Reply by Amy on
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Rooster having met many sleep techs and being one and having done DME set ups back in the day when we did not do sleep tests and we guessed at pressures I can say there are a couple of positives to sleep testing and some negatives. I think that there is a larger percentage that could be done at home because they refuse to come to the lab. I also think that under any condition there is not enough time to do a proper titration by a DME person. I was given a relatively short period of time to educate the patient, get my paperwork signed and an even shorter time for follow ups. Sleep labs do more then just titrate. We educate and encourate and make sure that the other issues are being addressed as well as the sleep apnea.
You undervalue the labs just like labs undervalue in home testing
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Economics needs to be considered. You are trying to do education and encouragement one-on-one and this is a very expensive way to do it. So expensive our society cannot afford it and so expensive it is currently leaving 85% of sufferers undiagnosed and untreated. Tell me just one other large area of education where students are educated with an instructor one-on-one? It is an unaffordable model.
I feel sure you are very sincere and competent in your professional efforts. But the model you work under must change.
Here is just a brief rough idea of a new model:
1. Home testing is the dominate (>90%) model for initial diagnosis.
2. A methodology for home titration is developed.
3. New or modified technology supports the home titration.
4. Sleep labs are reserved for special diagnostic cases and difficult titrations.
5. Education (and encouragement) is in classes of 25 to 30 patients.
6. Internet educational resources are available with instructor supervising large classes.
7. Formal patient support groups both in-person and on-line are formed.
8. All patients have the option of machines with software to monitor the therapy.
Competent, dedicated techs see their salary and job satisfaction growing because they are providing more benefit to many more people in a typical week. Other techs will be flushed out of the system.
This can be an excellent development personally for people like you.
Things must change.
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Rooster MD. I keep forgetting. How are people at home going to monitor and Dx minor muscle twitches while sleeping? You are right about arrythmias. They may go away with PAP treatment. They may not. Not wanting to know is atypical adult male response.
Things are changing. Just not fast enough for you evidiently. We are already reaching 30% more pts with the HST despite it's early weeknesses. Those numbers are only going to grow. This inconjunction with the PSG.
When the electric drill was invented we did not get rid of the hammer or the screwdriver. Instead we made toolbelts that could hold all 3.
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Permalink Reply by Banyon on
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Rock Hinkle said:When the electric drill was invented we did not get rid of the hammer or the screwdriver. Instead we made toolbelts that could hold all 3.
These days hammers and screwdrivers are are used little in manufacturing or building construction. It is automation, robotics, manufactured components, nailguns, and those drills you mention. Consumers are getting better value for their dollar and the same thing will develop with sleep studies - few in-labs and many home studies.
But you know my position on home studies versus sleep labs, so I won't expand on it in this thread.
Rock, I do notice that you are talking more about the use of home studies, so I assume you will eventually come around.
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Permalink Reply by 99 on
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i like my hammer and screwdriver and my electric drill
Rock Hinkle said:Rooster MD. I keep forgetting. How are people at home going to monitor and Dx minor muscle twitches while sleeping? You are right about arrythmias. They may go away with PAP treatment. They may not. Not wanting to know is atypical adult male response.
Things are changing. Just not fast enough for you evidiently. We are already reaching 30% more pts with the HST despite it's early weeknesses. Those numbers are only going to grow. This inconjunction with the PSG.
When the electric drill was invented we did not get rid of the hammer or the screwdriver. Instead we made toolbelts that could hold all 3.
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I am all for the homestudy Banyon. In conjunction with the PSG the HST allows me to reach 30% more pts. I have said that all along. The HST is an additional sleep tool that needs to be further developed. As it stands right now I have yet to see one that is any where near as good as THEY say it should be.
Now I could read 100 studies that say the HST is ready. I could also read 100 studies that would tell me what I need to do your job. Without ever having done your job do you think that those studies would give me the knowledge to tell you what you need to do it? I think not. The HST and auto PAP machines are not ready to replace anything. When they are I will be the first to endorse both. I promise that I will right a huge review and publish it on every sleep site known. Until then I am not coming around to anything.
I am still stuck on PLMS, arrythmias, and seizures being scare tactics. That is a very fanatical approach to saying that the PSG is no longer needed.
I grew up in a union ironworker family. We still use our hammers and screwdrivers. Most of the people that I know that do these kind of jobs still use very basic, all be it modern tools. We are not talking industr, manufacturing, or automation. We are talking healthcare. I do not know about you, but I still enjoy the small personal touches that I get from my providers. I would prefer that my daughters not ever have to go to an assembly line or medicine factory for their healthcare.
Banyon said:
Rock Hinkle said:When the electric drill was invented we did not get rid of the hammer or the screwdriver. Instead we made toolbelts that could hold all 3.
These days hammers and screwdrivers are are used little in manufacturing or building construction. It is automation, robotics, manufactured components, nailguns, and those drills you mention. Consumers are getting better value for their dollar and the same thing will develop with sleep studies - few in-labs and many home studies.
But you know my position on home studies versus sleep labs, so I won't expand on it in this thread.
Rock, I do notice that you are talking more about the use of home studies, so I assume you will eventually come around.
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