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[News] Polysomnography vs. the home sleep study: Which is better?
#1
Polysomnography vs. the home sleep study: Which is better?

by Sharon M. O'Brien, MPAS, PA-C

Insurance carriers are pushing harder for patients to have unattended home sleep studies versus in-lab polysomnograms. Their position is that home sleep studies are more cost efficient. But is it the best care for the patient?

In our sleep center, we see a large number of patients who receive referrals for potential obstructive sleep apnea. When performing a polysomnogram, it is not uncommon to discover other sleep issues that could be missed at home. These include bruxism, parasomnias such as REM sleep behavior disorder, periodic limb movements of sleep, and abnormal brain waves indicating nocturnal seizures.

Several months ago, I tested a home monitor myself. When I awoke, I found that the machine had stopped recording two hours after the study began. I may have hit the “off” button in my sleep, but we were never sure exactly what happened. Unfortunately, this is common. Technical failures occur in as many as 20% of home-sleep studies and are probably the biggest disadvantage of leaving patients unattended. In these instances, a repeat study is necessary.

Although polysomnography is the gold standard to rule out obstructive sleep apnea, if your suspicion is strong for this disorder and the patient has no other complaints suggestive of a comorbid sleep issue, a home sleep study may be considered. If the home study does not find obstructive sleep apnea, but the patient still complains of unrefreshing sleep and fatigue, an in-lab polysomnogram will be necessary to rule out other reasons for hypersomnia.

Home sleep studies do cost less and there is a place for their use. Such instances include patients who are unable to ambulate or those who are ill and unable to travel to a sleep lab. If there are no good sleep centers located near where a patient resides, and the only concern is obstructive sleep apnea, a home sleep study may also be good option in this situation. The patient or a caregiver will need to apply the monitor, so some instruction on use and care of the instrument will be necessary.

fair use from:
http://www.clinicaladvisor.com/polysomno...le/226158/

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.
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#2
Hmmm, I had wondered about PSG versus home studies.

I always thought the PSG was flawed, because it only records how I sleep the first night away from home....which is always different than how I sleep at home, or away after a few days....

I always seem to have a wonder night of sleep, the first night in a hotel. To where I had considered going to trips just so that I can get that night of sleep.

But, the sleep lab is supposed to isolate the kinds of things at home that might be affecting sleep quality. I say supposed to...because I always have trouble falling asleep if my feet are freezing....and the lab was freezing cold when they had me do my MSLT, and they didn't seem to care that I'd be rubbing my feet to warm them up everytime I was told to take a nap. OTOH, I also have trouble when I'm sweating under my mask.... during the night of the PSG it turned into a sauna. Though I heard it was even hotter for the patient in the other lab (at least I had gotten them to set up a fan in my room to help me sleep.) Giving me food poisoning during the MSLT probably didn't help either.... Also our sleep lab is next to the ambulance bays, and I can hear the train crossing out by the airport in the middle of the night from the sleep lab.

Sleep lab (psyc. services) and the ambulance bays are part of the old hospital...about a mile away from the new hospital. The train crossing is about 7 miles from the sleep lab.

The Dreamer
You may be a dreamer, but I'm The Dreamer, the definite article you might say!
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#3
(03-07-2012, 10:36 PM)TheDreamer Wrote: Hmmm, I had wondered about PSG versus home studies.

I always thought the PSG was flawed, because it only records how I sleep the first night away from home....which is always different than how I sleep at home, or away after a few days....

I always seem to have a wonder night of sleep, the first night in a hotel. To where I had considered going to trips just so that I can get that night of sleep.

But, the sleep lab is supposed to isolate the kinds of things at home that might be affecting sleep quality. I say supposed to...because I always have trouble falling asleep if my feet are freezing....and the lab was freezing cold when they had me do my MSLT, and they didn't seem to care that I'd be rubbing my feet to warm them up everytime I was told to take a nap. OTOH, I also have trouble when I'm sweating under my mask.... during the night of the PSG it turned into a sauna. Though I heard it was even hotter for the patient in the other lab (at least I had gotten them to set up a fan in my room to help me sleep.) Giving me food poisoning during the MSLT probably didn't help either.... Also our sleep lab is next to the ambulance bays, and I can hear the train crossing out by the airport in the middle of the night from the sleep lab.

Sleep lab (psyc. services) and the ambulance bays are part of the old hospital...about a mile away from the new hospital. The train crossing is about 7 miles from the sleep lab.

The Dreamer

they can tell you how many minutes you did sleep. you can still ask them. most people probably think they don't sleep long and are surprised at how long they did sleep. for the time you did sleep they can get good data from a multi-dimensional setup. you don't need to sleep at your best all night long to get a good study. now that you know more about all of this i suggest you have another talk with the sleep doc to discuss your concerns and get all the questions answered.
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#4
PSG is better, except when the patient doesn't sleep, or if he sleeps differently from home, or if he doesn't get the test done because of the hassle and expense.

Don't forget that a lot of apneacs go untreated because they've heard the horror stories and won't go get a PSG. I didn't even want to get an oximeter test because I thought this apnea was another thing to get you hooked into more doctor bills.

The PSGs are all too often just done as a way to ring the cash register without doing what's necessary to do the test right. We've all heard horror stories about noisy rooms, hospital intercoms blasting away during the night, cold or hot rooms, uncaring technicians slapping FFMs on patients, etc. They should always have a sleeping pill available for patients who can't get to sleep. For my test, I had problems because I almost always sleep in a recliner, and my only choice was to start the test at 7 PM or some such ridiculous time. At that time, I almost never could get to sleep before 2 AM or so, even at home, so I had to get a sleeping pill and come back another night.

On the other hand, in home tests really should be improved. It should not be just a one night thing. The emphasis is hook this up one night, take whatever data can be taken, ring the cash register, and done. It should really be set up to go for several nights if necessary, check the results via phone line or wireless. Then do an at home titration and further study with a CPAP machine with a data connection. Tinker until you get it right and then do a PSG if necessary.
Get the free SleepyHead software here.
Useful links.
Click here for information on the main alternative to CPAP.
If it's midnight and a DME tells you it's dark outside, go and check it yourself.
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