Post Reply 
[News] More sleep labs, more unneeded tests
Author Message
ApneaNews Offline
Apnea News Correspondent
Advisory Members

Posts: 170
Joined: Feb 2012

Machine: IBM Selectric II
Mask Type: Full face mask
Mask Make & Model: 3M N95 (it gets dusty in the newsroom)
Humidifier: Sears Kenmore (circa 1979)
CPAP Pressure: 3200 psi
CPAP Software: Other Software

Other Comments: I report, therefore I am.

Sex: Undisclosed
Location: In the newsroom (where else?)

Post: #1
More sleep labs, more unneeded tests
Inside Medicine: More sleep labs, more unneeded tests

By Dr. Michael Wilkes


Celeste can tell you it is no fun to sleep with, or near, someone who snores. She told her husband's doctor that he has snored for over a decade. Finally she felt she had no choice but to move to another bedroom. For the first time in very long time she now sleeps through the night. Her doctor suggested her husband might have sleep apnea and suggested an overnight sleep study.

Sleep apnea is defined by bouts of snoring, daytime fatigue and periods during sleep when breathing stops. It is much more common in older, heavier men and much more common in those with diabetes. It can result in a person being chronically tired, and it has been associated with an increase in the rate of motor vehicle accidents and other health conditions.

The problem is that a huge number of people snore but only a few actually have sleep apnea. Some experts have called for wider testing of all snorers – but herein lies the problem.

Sleep studies are all the rage these days. They are expensive tests and require an overnight stay and close monitoring. But are they any more accurate than the doctor taking a good history and performing a careful physical exam?

In one study, four simple questions asked by the doctor and a home monitor were just as accurate as a fancy sleep study.

The number of sleep labs has quadrupled in the past decade, perhaps because the test can generate $1,900 per study – even more if the person spends two nights in the lab. A quick Web search turns up companies that offer to help doctors set up money-making sleep labs – most suggest that a small up-front investment can quickly turn into large profits. Some of these companies even suggest that doctors work with a local hotel that has unfilled rooms.

This is another example of technology driving the practice of medicine. Owning a sleep lab creates a lucrative incentive for doctors to use more of the test than is necessary. I suspect doctors who own sleep labs are far more likely to order sleep studies than are doctors that have no ownership stake.

Yes, we have an obesity epidemic, a diabetes epidemic, an aging population and perhaps a snoring epidemic. But the answer is not to offer an expensive test to everyone who has even the slightest chance of being at risk. The answer going forward is to move away from reimbursement systems that provide doctors a profit if they order tests.

Celeste's husband has lost 15 pounds and uses a mouthpiece to help with snoring. She's not ready to move back into the bedroom yet, but she hopes to after the next 10 pounds.

Michael Wilkes, M.D., is a professor of medicine at the University of California, Davis. Identifying characteristics of patients mentioned in his column are changed to protect their confidentiality.



fair use from:
http://www.sacbee.com/2012/09/13/4813411...eeded.html


The above post may contain copyrighted material the use of which has not always been specifically authorized by the copyright owner. The material available is intended to advance the understanding of Sleep Apnea treatment and to advance the educational level of Sleep Apnea patients with regard to their health. Sometimes included is the full text of articles and documents rather than a simple link because outside links frequently "go bad" or change over time. This constitutes a "fair use" of any such copyrighted material as provided for in section 107 of the US Copyright Law. In accordance with Title 17 U.S.C. Section 107, the material in this post is distributed without fee or payment of any kind for research and educational purposes. If you wish to use copyrighted material from this post for purposes of your own that go beyond "fair use", you must obtain permission from the copyright owner.
01-08-2013 11:33 AM
Find all posts by this user Post Reply Quote this message in a reply

Donate to Apnea Board
zimlich Offline

Preferred Members-2

Posts: 392
Joined: Feb 2012

Machine: Respironics PR System One BiPap Auto SV Advanced
Mask Type: Nasal mask
Mask Make & Model: ResMed gel Nasal Mask
Humidifier: System One
CPAP Pressure: 8-20 ASV, 8 EPAP,PS 12
CPAP Software: Not using software

Other Comments: I use the Quattro FFM when necessary

Sex: Female
Location: Norfolk, VA

Post: #2
RE: More sleep labs, more unneeded tests
This is very interesting. In the study she referred to- four simple questions and a home monitor that were just as accurate as a fancy sleep study. More information would have helped. What were the four simple questions? In our desire to help the undiagnosed knowing these questions would be helpful. And what did she mean by a home monitor. If it's just a pulse ox- I have moderate sleep apnea and never in six sleep studies and two at home pulse oximetry tests have I desaturated. A pulse ox would miss me. I went to my GP because of quite excessive daytime sleepiness that seriously impacted my life- he suggested the sleep study and the Pulmonologist Sleep Specialist concurred (2008). In people who are otherwise in good health perhaps the simple way of diagnosing would work, but this leaves the job of titration sort of up in the air. I'm sure sometimes this would be accomplished with little effort. We are so individual in our pressure needs for some folks this might be time consuming and difficult. I believe home testing when done to gather as much information as possible and graded by an accredited person overseen by a sleep specialist would fit the bill for some of us. Others with high blood pressure, COPD, heart problems, etc. should probably be supervised in the lab, even if only for titration. Thanks for posting the article.
Sure would like to know those four questions. I'll Google them.
Mary
01-08-2013 01:19 PM
Find all posts by this user Post Reply Quote this message in a reply
aehjr Offline

Preferred Members-2

Posts: 92
Joined: Dec 2012

Machine: ResMed S9 AutoSet
Mask Type: Nasal mask
Mask Make & Model: Mirage FX
Humidifier: ResMed S9 H5i
CPAP Pressure: 6 - 12
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: Colorado

Post: #3
RE: More sleep labs, more unneeded tests
(01-08-2013 01:19 PM)zimlich Wrote:  (snip) What were the four simple questions? In our desire to help the undiagnosed knowing these questions would be helpful. And what did she mean by a home monitor. If it's just a pulse ox- I have moderate sleep apnea and never in six sleep studies and two at home pulse oximetry tests have I desaturated. A pulse ox would miss me. I went to my GP because of quite excessive daytime sleepiness that seriously impacted my life- he suggested the sleep study and the Pulmonologist Sleep Specialist concurred (2008). (snip)
Sure would like to know those four questions. I'll Google them.

Agree on all counts. During my first sleep study (2008) I desaturated a lot (down to 70% during events). Been using a fixed pressure CPAP ever since. I went back to my GP early in 2012 due to excessive fatigue. He ordered two home pulse oximetry tests; neither of which indicated a desaturation issue. I got off my butt and went to a pulmonologist after this site showed me how to change the settings on my CPAP so I could see the efficacy data. When I saw my seven day average AHI between 7 and 14 on a regular basis (and never lower than 7), I called a pulmonologist. Still waiting for the appointment to discuss the sleep study but the tech told me "your pressures were all over the place."

Would love to know what four questions would have provided the doctor the needed info...
01-08-2013 01:37 PM
Find all posts by this user Post Reply Quote this message in a reply

Donate to Apnea Board
Shastzi Offline

Advisory Members

Posts: 1,174
Joined: Dec 2012

Machine: ResMed S9 Autoset
Mask Type: Full face mask
Mask Make & Model: FitLife Total face mask
Humidifier: F&P HC150 with Hybernite heated hose.
CPAP Pressure: 15cm-20cm H2O (auto)
CPAP Software: SleepyHead Other Software

Other Comments: CMS50-F wearable Oximeter; Software: SPO2 Assistant

Sex: Undisclosed
Location: Florida, USA.

Post: #4
RE: More sleep labs, more unneeded tests
aehjr:
Perhaps you may need to snag a wearable pulse oximeter and run the monitoring for a week.
#1. It is possible that your two night snapshot missed any real desaturation events but other issues with the environment kept you awake so you never got the chance to get any real de-sats going.
I say that because a friend of mine had a single night oximetry run but the equipment cables and bulky device he was issue kept him awake all night. He went off thinking he is ok, but truth is, no one knows for sure since no one did any cross checking. The device results were accepted as gospel and this is the real travesty.

#2. I have seen a few scary demonstrations of pulse oximeters turning in *false negative* results!
The patent, under controlled conditions was purposefully put into known desaturation conditions and
some oximeters *missed the event*..!
Keynote here is trust...but verify!

#3. I think you are doing the right thing in checking with the pulmo specialist. You might need to lean on them a bit harder though.

Best of luck!
01-08-2013 08:56 PM
Find all posts by this user Post Reply Quote this message in a reply
Post Reply 


Possibly Related Threads...
Thread: Author Replies: Views: Last Post
  How long until changes in blood tests or medications? NorthernGuy 11 759 09-04-2016 07:46 PM
Last Post: Mosquitobait
  Sleep Tests in NYC? Yawn Boone 3 678 10-11-2015 08:11 AM
Last Post: robertbuckley
  Multiple sleep tests roym 17 3,590 09-10-2015 11:13 PM
Last Post: PollCat
Ohmy Pulmonary Fitness Tests kingskid 6 1,872 05-09-2015 08:11 PM
Last Post: kingskid
  What tests can my PCP run before sleep doc appointment? nila 21 3,925 06-25-2013 06:17 PM
Last Post: RonWessels
  Home Sleep Tests: Are they the future for OSA Diagnosis? SuperSleeper 16 6,603 05-11-2012 05:27 PM
Last Post: SuperSleeper

Forum Jump:

Who's Online (Complete List)