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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 Rooster on
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99 said, "you have skillfull side stepped my question just like polititions, what is your answer and are you a politition"
99, You have me laughing. :) If you want to use the word "politician", let me tell you that you are trying to be a politician. You want to fix a question in such a way that it is a trap, by eliminating that which cannot be eliminated.
Economics cannot be eliminated from the decision making process. Economics has been with us, is now with us, and will always be with us.
Anyway, read my whole reply again and you will see I did answer your trap of a question.
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Permalink Reply by 99 on
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everybody wants the best, fact
weather they get the best is another thing
it is great that should the best be not practical then home testing would be most welcomed
but just because you want the best do not mean that you will settle for less, you take what you can get, that is wisedom
i said let us put aside wisedom and if you had a choice which would you choose
i would choose the lab PSG if a choice was given to me, should there be no choice, i would be grateful for a home study
i have answered how i would answer now it is your turn
Rooster said:99 said, "you have skillfull side stepped my question just like polititions, what is your answer and are you a politition"
99, You have me laughing. :) If you want to use the word "politician", let me tell you that you are trying to be a politician. You want to fix a question in such a way that it is a trap, by eliminating that which cannot be eliminated.
Economics cannot be eliminated from the decision making process. Economics has been with us, is now with us, and will always be with us.
Anyway, read my whole reply again and you will see I did answer your trap of a question.
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Permalink Reply by Kath Hope www.hope2Sleep.co.uk on
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This is all very interesting to read. Thought you may be interested to know that the majority of UK have Home Study Tests as many hospitals don't have the facilities for hospital testing. I personally preferred this, as I'm sure I slept better with the equipment in my own bed than I would have on a hospital ward. Beggers can't be choosers lol. Our health system works very differently to yours though, as we are all entitled to the test, a cpap machine and 2 masks per year under the NHS. We don't have as much choice though of what we get. Some people do take the private route, due to ignorance from the doctors who refuse to have them tested, but even then they pay for loan of a home study.
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Permalink Reply by Banyon on
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Kath Hope www.hope2Sleep.co.uk said:This is all very interesting to read. Thought you may be interested to know that the majority of UK have Home Study Tests as many hospitals don't have the facilities for hospital testing. I personally preferred this, as I'm sure I slept better with the equipment in my own bed than I would have on a hospital ward.
I am with you Kath! If I ever have another sleep study, I want it to be in my own bedroom under the conditions I normally sleep in. Bring on that home equipment.
There is an assumption in this thread that everything is just dandy when a sleep lab does a study. I can't find the reference now, but a noted sleep doctor has written that it is not uncommon to require up to three nights in his sleep lab before the appropriate positive results are obtained, so false negatives are a fact of life with sleep labs. In this book, Deadly Sleep, Dr. Mack Jones describes his frustrating travails with false negatives in the sleep lab for his own condition.
Then there is my personal experience with three nights in two certified labs. The positive diagnosis was easy due to the severity of my condition. However, during those three studies the doctor and lab failed to completely diagnose my condition and failed miserable to get an appropriate titration. I finally did a successful titration at home with help of my data-capable CPAP, recording pulse-oximeter, and patients from internet forums
So I definitely want my next study to be at home with the portable equipment!
I also agree with the point that it is a huge mistake to ignore economics. This is a very weak point in all areas of medicine and will have to change.
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Permalink Reply by SleepMBA on
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I see JNK's point about the thoroughness of an in lab study. For instance, in my lab we run at least 21 channels. Type II home studies run 7 channels. Type III home studies run 4 channels. My point is: by going to a sleep center, you will get a lot more data. Data that can be invaluable when it comes to diagnosis of a sleep disorder. 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.
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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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jnk said, “My biggest concern is that such machines are too often used to make an end run to circumvent sleep doctors completely in treating patients who could benefit from consulting with sleep doctors.”
That is news to me. Locally the only people using portable home equipment are dentists and doctors certified in sleep. The family practice I use has a contract with a sleep doctor who prescribes and supervises the home studies as well as the in-lab studies. My favorite dentist, who has no sleep training, fits MADs and works closely with some sleep doctors who prescribe and supervise the portable home studies to test the effectiveness of the MADs. (He also will not make a MAD without a letter from your sleep doc prescribing it.)
But I would have no problem with GPs using portable home studies without consultation with sleep doctors. If they do a good job, they are going to improve the health of many people quickly and somewhat inexpensively. If they do a poor job, their poor reptuation will spread quickly and they will have no patients for sleep studies.
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Permalink Reply by Amy OHare on
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"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 CleveMed on
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Just wanted to share a couple of videos that could contribute to this discussion. This is one sleep doc's view on Home Sleep Testing:
Home Sleep Testing as current and emerging trend in Sleep Medicine:
http://www.youtube.com/watch?v=XVxynDOyPbQ
Will Home Sleep Testing Replace the Sleep Lab?
http://www.youtube.com/watch?v=EjITh_YJnxw
The role of Home Sleep Testing in long term management of OSA
http://www.youtube.com/watch?v=U3dwx13B4Ek
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Both my husband and I have UARS. I don't believe an at-home sleep study would catch that.
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"While a night in the sleep lab may be more comprehensive, costs and care associated with the home test systems may be more reasonable. The home unit used at BlueSleep costs the center about $1 to $2 per study—the cost of the batteries and the skin sensors. Additionally, other devices charge a fixed amount per study and a one-time fee for use. .... If portable monitors really take off, it will just bring more people into the sleep lab,” he says. http://www.cardiovascularbusiness.com/index.php?option=com_articles..."
Also from the same article, "“The medical profession as a whole over the last 15 years was relatively unaware of the implications of sleep apnea,” says Virend K. Somers, MD, PhD, director of the Sleep and Cardiovascular Clinical Research Units at the Mayo Clinic in Rochester, Minn"
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Permalink Reply by Amy on
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So I being an opinionated person will say what I am going to say from experience. Our lab owns a home sleep test machine. Almost no doctor orders it and this that do order it for patient who do not qualify for home sleep test such as nueromuscular patients or end stage COPD.
The issue with home sleep testing is not that it is useful but really will it be used correctly. We the patient then be put on an autopap? Will it be used correctly by the patient? I have had several patient I had to redo the study on because they did not apply it correctly or they figured 2 hours was all I really needed because they could not sleep with the equipment on. I am also finding that some people are sharing insurance and so I would not know if maybe they put the machine on someone else who has no insurance who needs a cpap.
Just a few thoughts.
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