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Home Sleep Tests: Are they the future for OSA Diagnosis?
Robb W Wrote:Preaching to the choir. And I am sorry that I used the abbreviations in my post. A bad habit that I got into when doing my notes. (yes Pt is short for patient) I never use the long version of HST because I don't agree that it is a "Sleep Test" at all and I disagree fully with the term test. I think that it should be called a Home Apnea Screening Tool. The word test indicates something that suggests success or failure and a study is a win-win situation as far as I am concerned.

I am not just a technologist. I am a CPAP user myself and I have been one far longer than I have been a tech. I firmly agree that if a patient is ambitious enough, he/she SHOULD and is fully obligated to take some responsibility for their treatment. An MD is not infallible and unless they are fully specialized in Sleep Medicine are not qualified to write anything but a prescription. We don't know who read that Home screening and assessed the Periodic Limb Movements of Sleep (PLMS) but they were way off in the diagnosis based on the tools they were using.

With 70% of the business being drawn away from the labs to home studies, something in that technology will need to improve in order to take into account the undiagnosable sleep disorders. This will in turn cost money which will end up driving up the cost of the home screenings. But the improvements will not let people slip through the cracks.

I remember when I was diagnosed in 1999 it was a rare occurrence that people were sent for lab studies. I often think about all those parents that died of cardiac issues and strokes before their 70s and I am sure you will find that they had undiagnosed OSA or something related. Especially if their children were later diagnosed with OSA in a sleep study.

The fact that we are saving lives and adding to the quality of other people's lives is why I do what I do. I am fully in it for the patient and not the paycheck.
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Gavino V Wrote:Robb, I remember from previous posts of yours on other topics that you are a user, so no disrespect meant there.

Also, I wrote (I thought quite clearly):

"The people on this thread who are professionals are obviously concerned about doing the right thing by the "pt". They sound like the kind of people who, if they did the study, might go out of their way to make sure the physician took note of notable things. All that is good and commends getting the full study done."

And yeah, I knew you were "preaching to the choir" and that's fine - it seems, regrettably, that most of the people in these discussions are professionals and not solely users. I say "regrettably" because a mix would be best. We users do not see a variety of patients - we see our own experience, and maybe share with one or two people that we know. Other than that we're in the dark. I, for one, was not aware that there were such things as "home sleep tests" or HSTs or whatever terminology you're comfortable with. My own experience - and everyone I know - was to have a full out study at a sleep center. I wasn't aware of an alternative, and my pulmonologists, to their credit, I think, both were adamant about the sleep study being Step One.

My point is that there is a wide, wide variation in the quality of pulmonologists - from the stand point of the patient, specifically their need for information and options. And yes, the insurance companies do have a lot to say in terms of cost implications. But what I can see from the British on this thread is that single payer would not be incentivized differently - maybe worse, from the standpoint of cost cutting (govt budgets being what they are).

I actually learn a lot in this forum, both from professionals and from "civilians". A great amount is ex post facto, however - I wish, for example, that I had known about Auto-PAPs before I was shunted to a "support" company that palmed nearly obsolete equipment on me with incomplete information about how to get data out - or even if it could be done. I spent $1100 of my own money to recover from that. It was worth it.

But were the "professionals" involved acting in my best interest?

It wouldn't surprise me if 75% of all patients were not able to digest - and not even looking for - information that would help them make intelligent choices. Most patients are like, Hey doc, help me out - and tell me what to do. And they implicitly trust the professionals - MDs, their staff, the sleep study people, the vendors of equipment - to be doing right by them.

Sadly, in my experience, and the experience of others I know, that is all too often not the case.

But from the comments in this thread, altho I challenge you all quite a bit, on the whole I am convinced that you all have our best interests at heart, in the main.

Robb W Wrote:Agreed

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Robb W Wrote:Kath, I went to your site and I am very interested to see how those Sleep Strips work. My 15 year old son refuses to believe that he may have OSA due to either tonsils or an inherited small airway (also my problem). I have been trying to find a way to test him and he refuses to go to a lab. I never argued with my parents when I had to go to the doctors the way my son does. You would think that having a Dad that is a tech would be enough to trust judgement. However, not the case.

What is the youngest age that those strips can be used?

Kath H Wrote:Rob, you are in exactly the same position as I am with my kids - both of them need testing for different reasons, but won't hear of going down 'the route' in case they have to use CPAP. However, my son has agreed to use a Sleep Strip (he's 17) and my daughter promises to investigate it before she's ready to start a family.

In answer to your question, there's no set age - just says they're not suitable for children. I'm guessing it's because the probes might not end up in the correct place for the nostrils, due to them only being one size. It could also be the fact that children may pull them off in the night. I can't think of any other reasons can you?
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Robb W Wrote:nice. I am going to talk to my wife and see if she thinks buying one of those may be beneficial. I assume that if I was to pick them up at your store they would be about $60 USD? I am not sure what the UK conversion is.

Kath H Wrote:Think it only works out at around $48 plus shipping actually, but international customers usually pay via Paypal which converts it automatically.
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IDS Wrote:Hi there, my name is Stacie Felice and I work for [company name removed]. We are a diagnostic testing facility specializing in Overnight Pulse-oximetry testing and Home Sleep Testing.

A lot of people are "afraid" of home sleep testing as they see it REPLACING sleep labs. That is not the case at all. Home Sleep Testing (HST) is used for diagnosing OSA ONLY. For any other sleep related issues, the sleep lab will always be required.

The pool of potential OSA patients out there is MASSIVE. There is no way sleep labs can manage that many patients.

There are also A LOT of older patients out there who cannot or will not travel to a sleep lab, this form of testing is ideal for them. We have also encountered a lot of patients who would have to travel long distances to a sleep lab where they could incur hotel costs and what not for spouses, etc. As someone mentioned above, HST does have its place.

And yes, Gavino, your doctor would have to order a Home Sleep Test for you just as any other medical test. Once ordered, we would call to schedule your HST. We would ship it to you the same day and you would receive it in 2-3 business days. You would test with it the night you receive it and mail it back the next day in a pre-paid envelope.

Once we receive it, one of our board certified sleep doctors will interpret the test results. When we receive the results back from him, the results are immediately faxed to your physician.

It's as easy as that. =)
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Kath H Wrote:That's interesting IDS...... didn't realize doctor's had to order a Home Sleep Test. Anyone in the UK can arrange to have a Home Sleep Test without a doctor's referral. In actual fact, most people who take this option do this because their doctors do not take their symptoms seriously Sad Hence the fact that we sell the sleep strips so they can taken them as evidence to their doctor's to be referred to the hospitals. If a doctor does refer a person for a sleep study, they do not have to pay for this, as it is covered under the National Health Service here. The problem likes with persuading the doctors to send them!

IDS Wrote:Wow. That's interesting, Kath. I wonder if more folks would do it by themselves over here in the states if they could? Thanks for your info!!
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Robb W Wrote:I disagree with you on a lot of what you said Stacie. If what you said was true, then tell me why the patient volume bottomed out in a lot of labs in MA when insurers opted for HSTs as a first line diagnosis tool for OSA? Why did at least four labs that I know of close their doors? Why did good techs lose jobs?

HSTs will reach a lot of people, this is true. But insurance companies are looking at it as a way to cut costs instead of reach more patients. Insurance companies do not care about how many patients are being reached. They care about how much money can they save and still reach those that want to be reached.

It should not affect the amount of in-lab studies being done. It should broaden the number of people being diagnosed while maintaining a healthy volume.
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