Home Sleep Tests: Are they the future for OSA Diagnosis? - Printable Version +- Apnea Board Forum - CPAP | Sleep Apnea (https://www.apneaboard.com/forums) +-- Forum: Public Area (https://www.apneaboard.com/forums/Forum-Public-Area) +--- Forum: Main Apnea Board Forum (https://www.apneaboard.com/forums/Forum-Main-Apnea-Board-Forum) +--- Thread: Home Sleep Tests: Are they the future for OSA Diagnosis? (/Thread-Home-Sleep-Tests-Are-they-the-future-for-OSA-Diagnosis) Pages:
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Home Sleep Tests: Are they the future for OSA Diagnosis? - SuperSleeper - 05-11-2012 Apnea Board has a Linkedin.com discussion group and I thought this particular discussion was interesting enough to copy & paste over here. There were some commercial links included, and these have been removed to comply with our forum rules. Also, full names have been edited to just first names and last initials in order to preserve the privacy of the original posters. Feel free to add to the discussion by replying in this thread. Here's the Linked thread, copied: SuperSleeper Wrote:Home Sleep Tests: are they the future for OSA diagnosis? RE: Home Sleep Tests: Are they the future for OSA Diagnosis? - SuperSleeper - 05-11-2012 Kath H Wrote:Most tests here in the UK are done at home, as we don't have that many sleep labs. Rick C Wrote:People in the insurance industry in the US are projecting that 70% of osa diagnositc studies will be done in the home. There are positive and negative ramifications. More osa will be diagnosed and treated. The nuances of sdb, uars and central apnea issues will tend to be overlooked to the detriment of the patient. Many patients may fall through the cracks as contact with sleep docs and more importantly support personell will shrink. The little support for patients needing pap therapy will become smaller. DME's will sell more masks and machines, insurance companies will save money, doctors will read and interpret hst studies and it will all appear fine. In my practice, every day, I meet people who feel through the old system. I fear that number will grow. Robb W Wrote:It is a good thing to fear. And further to this, only the really challenging patients will end up in the labs. This will cause tremendously more stress for the professional. RE: Home Sleep Tests: Are they the future for OSA Diagnosis? - SuperSleeper - 05-11-2012 Kath H Wrote:No Rob, we are sent home with the equipment, eg [link removed] Robb W Wrote:The link that you posted did not work. However, that is depressing. There must not be a huge need for techs in the UK. Kath H Wrote:Sorry Rob, am nor sure why the link doesn't work in here, but I just copied it pasted it into my browser and it works from there.You are correct in saying that other disorders will be missed, and I've heard of several people taking private home studies - they never see a medic at all just purchase a machine and masks. However, they later discover they have CSA, instead of or as well as, OSA and are on the wrong machine As for compliancy.... difficult to state, but I do know for a fact that 100's of people here in Europe have told me personally, that without finding my company [link removed] and the comfort products we supply, they would not be using their machines. My inbox is always full and the 'phone always ringing, of people needing extra help they don't get from the clinics, and it's for this reason I started the forum up [link removed] There are now local support groups popping up over the country (similar to your AWAKE meetings), but sleep apnoea is only just recently reaching the general public over here, so hopefully things will rapidly improve. RE: Home Sleep Tests: Are they the future for OSA Diagnosis? - SuperSleeper - 05-11-2012 Gavino V Wrote:Robb/Kath - the link provided does NOT work if you try it from Linked-In, but, oddly, DOES work if you copy it an paste it into the url bar of your browser... Go figure... Robb W Wrote:Their is some logic and has been some effort to approach diagnosis that way. However, unfortunately the only thing that the HST will screen for is apnea. There are other considerations in home studies that I feel also contribute to the inaccuracy. These include environmental factors such as a bed partner with untreated sleep disordered breathing, or sleep related movement disorders, allergies, pets, etc. All of these are control factors that in a lab can be isolated to just the patient related issues. These factors can be addressed if there is still no physiological evidence. But since most patients never tell the whole story to their physicians(or even know that they are leaving anything out), the only way to observe any aberrations require a more objective approach. RE: Home Sleep Tests: Are they the future for OSA Diagnosis? - SuperSleeper - 05-11-2012 Kath H Wrote:I agree with your Robb, but after all my campaigning, and that of the British Lung Foundation's OSA Campaign which is currently underway supported financially by Philips Respironics [link removed] , I'm just thankful that at least people are getting tested and diagnosed now. However, hoping for great strides in improvement here in the UK. Rick C Wrote:It's obvious that money is a huge force behind the changes in diagnostic and treatment practices. And while none of us is so naive as to think it should not have a place in the process, it's a shame that it drives so much of the decision making. Perhaps the upside is that osa is a relatively small piece of the cost that insufficient sleep creates for business and for insurance companies. The latest changes surrounding HST have also influenced and dramatically limited the behavioral treatment of insomnia and parasomnias. Insurance companies still reimburse inadequately for these treatments and now with the damage done to sleep labs by HST behavioral departments are suffering. As we educate the public, business and the non-sleep professionals our message will finally begin to register. They may begin to understand that if we only diagnose and treat osa, and if there is little support for long term patient adherance, the results will ultimately be dismal. And the cost of sleep disorders will remain almost untouched. Good discussion folks. RE: Home Sleep Tests: Are they the future for OSA Diagnosis? - SuperSleeper - 05-11-2012 Robb W Wrote:Since we are on the topic of HSTs and what they can and cannot diagnose; I have an interesting case story to share to drive home the issue. Kath H Wrote:Scary stuff Rob To tell you the truth, there are very few places people can go to here for checks on sleep disorders, but hopefully as people as becoming more aware of OSA, the other disorders will get the attention they deserve. Meanwhile, at least the HST's are catching plenty of folk. My own Dad's having one this Wednesday. Rick C Wrote:Amazing Rob and well stated. I had a client last week who has been complaining to his pcp for the past 18 years of very poor sleep. He's fallen asleep at the wheel and has his wife drive him to work, and has excessive daytime sleepiness. He has had some observed apneas and occasionally snores. He's also overweight. His pcp has responded by prescribing benzodiazopines and sedatives. While working on improving on his sleep, I strongly suggested that he ask his pcp for a sleep study, and not take no for an answer. This is a story I have heard time and time again with minor changes in details. RE: Home Sleep Tests: Are they the future for OSA Diagnosis? - SuperSleeper - 05-11-2012 Kath H Wrote:I have lost count, Rick, of the amount of people who've contacted me wondering if they have OSA when all their GP's keep doing is prescribing more and more sleeping pills, thus making their condition worse Rick C Wrote:I believe it Kath. We have so much work to do educating the general public and the medical community. So far I've much better outcomes teaching my clients and the general public. When pressed many of the pcps acquiesce, though they think it's foolish and unnecessary. Kath H Wrote:I'm with you on that Rick - the challenge is HUGE, but just 'hope' our small voices are heard! On our website we sell the Sleep Strip [link removed] (which isn't allowed to be sold in the US) and many people buy this over here to convince their GP's they need referring for a full sleep study (our health system is very different here). The Sleep Strips are very accurate too! Shame the US won't allow them to be sold without a prescription, as they're only the same thing an off-the-shelf pregnancy test is Kath H Wrote:Ha Ha Rick and Rob.... I've been looking at your profiles and it seems we're all musician too. It's not on my profile, but I teach the piano and keyboard in my spare time - not that I have much of that these days RE: Home Sleep Tests: Are they the future for OSA Diagnosis? - SuperSleeper - 05-11-2012 Gavino V Wrote:Wait a minute... How would a "civilian" - me, say - get my hands on an "HST" (the jargon is absolutely killing me... "pt" for patient, I presume? Nice and dehumanizing, thanks..)? Would not a physician of some kind have to prescribe one? Would it then not follow that the physician would have to be able to interpret the data within the context of the actual patient? RE: Home Sleep Tests: Are they the future for OSA Diagnosis? - SuperSleeper - 05-11-2012 Rick C Wrote:Nice site Kath. You have a lot of good products that I often recommend to clients about to begin or strugling with pap therapy. I'd have to see more background to comment on the strips. Rick C Wrote:I think our efforts are best spent on informing people so that they can advocate for themselves. Pcps can prescribe a home sleep test but it must be read and interpreted by a sleep doctor. A sleep doctor would approacg the choice between in lab and hst as you described. But the difference here in the US is that the insurance company also has a great deal of authority in the final decision. One of the big drawbacks in the use of hst and the strips that you described is that they don't measure sleep. And so we don't know if breathing episodes are occuring in sleep or wake. RE: Home Sleep Tests: Are they the future for OSA Diagnosis? - SuperSleeper - 05-11-2012 Kath H Wrote:People here in the UK and in fact all of Europe tell me that they wouldn't be CPAP-compliant without the products we stock. I agree, as I wouldn't either! However, I was determined to be compliant due to my own mother's untimely death at the age of 49 of a heart attack (most probably caused through her undiagnosed OSA). This is where my passion comes from. Rick C Wrote:Sleep well and have good dreams. Danielle V Wrote:Sad to hear those comments. |