Why Are Centrals NOT Detected on Titration?

[rozenbob]

While researching my previous sleep study from Oct 2015, I noticed it reported 0 Centrals.

Both Rescan and Sleepy Head show centrals (between 25% and 75%) months before the study until now.

Now after taking an ASV titration ln June 2016 (which shows 0 Central as it should), the DME is refusing to submit my Sleep Doctors RX for the ASV since the prior titration showed No history of Centrals.

Why do both the Rescan and Sleepy head show Centrals, while the titration does not?[b][/b] Has anyone had a similar issue trying to get approval?


By the way, when I called the Insurance authorization dept, they said the ASV would be approved....but the DME insists that my paperwork does NOT meet Billing criteria for Medicare.

[LSAT]

The % doesn't mean anything......What are the events per hour?

[palerider]

the DME is refusing to ....but the DME insists that my paperwork does NOT meet

simple, get a different DME.

also, the software reports centrals because the machine detected and logged them.

as to sleep studies... they may be "The GOLD Standard", but they are, in many ways, woefully inadequate if you think about it.

you're in an artificial environment, all wired up and less comfortable than normal.
it's *one night* and likely only part of that night. reading any titration report, you'll see that "oh, your good pressure was 12cm, you slept for 45 minutes at that pressure!"

it's a simple fact that sleep varies from night to night, you'll have better and worse days with the same exact settings. yet the "gold standard" is a small number of minutes tested on one night.... a brief photograph taken during the marathon run that is your sleep.

it's not surprising that sleep studies are somethings quite wrong, what's surprising is that they're ever right!

[ChicagoGranny]

Both Rescan and Sleepy Head show centrals (between 25% and 75%) months before the study until now.

How many events are you having per night, and how long are they?

By the way, when I called the Insurance authorization dept, they said the ASV would be approved

I'd be careful with this. Getting information over the phone is no guarantee that the insurance company will pay.

Most insurance companies require proof of central or complex apnea from a doctor before they approve payment for an ASV. What has your doctor submitted for proof?

[rozenbob]

After going through files:

First polysomnoraphic report 7/19/2006 showed 30 Centrals (Mean Duration 23.7 and Max Duration 42.0) . Approx 6 hours sleep with178 Events .

First CPAP titration 07/29/2006 showed 27 Centrals ) Mean duration 21.9 and Max duration 35.5). Sleep time 265 minutes with 27 events per hour during REM and 20 events per non REM.

Second (and most recent) CPAP 10/04/2015 showed 0 Centrals (despite High Readings on SH and Rescan for several months) with 129 arousals.

Bipap Auto SV Titration 6/21/2016 showed 0 Centrals. Slept 260 minutes with 52 total arousals.

The last two reports also indicated PLMs

[rozenbob]

Granny;
I believe that is why my DME has not filed since it appears that my current sleep Doctor only provided the last two Titration reports with the Rx for an ASV.
I was hoping that the two earlier reports might help to meet all criteria?

[ChicagoGranny]

If it were me, I would insist the doctor write a justification for ASV to the insurance company. Then I would try to get a written approval from the insurance company. A good doctor will help get the approvals.

[ChicagoGranny]

I should add the doctor's written justification would include copies of whichever reports he is relying on.

[ChicagoGranny]

the DME is refusing to ....but the DME insists that my paperwork does NOT meet

simple, get a different DME.

The current DME may be helping Rozenbob by preventing he take delivery of a machine that the insurance company will refuse to cover.

[rozenbob]

I like and trust my DME and they explained their actions. I have used DMEs such as Apria (that would not hesitate to issue premature and over bill) with this in mind, I have no intention of leaving my current dme.

I hope to have the chance to discuss this with my sleep Doctor while at his sleep clinic in two days.

Thanks Granny

[jnk...]

What home machines report as "centrals" are often ignored during sleep studies. That is because the pauses in breathing may be related to changes in sleep states, or from wake to sleep, and are thus unrelated to breathing problems and more related to sleep problems. All the home machine knows is that you paused your breathing and part of your airway was open. It doesn't know if you were asleep or awake. It doesn't know if you had a limb movement. It doesn't know if a car backfired. In a lab with proper scoring, some of those events will get ignored because they SHOULD be ignored, if evaluating sleep-breathing. For example, since you mention the PLMs, SH can't score those. So if PLMs cause you to shift gears from one form of sleep to another, the lab will score it as PLMs, not centrals. Rightfully so. SH will think you are having open-airway apneas and report them as such. Basically, it will be wrong.

Now, I'm not saying that is the case with you, but still--no self-respecting payer will take the word of a machine that was never designed to diagnose sleep disorders over the word of a sleep doc looking at a properly-scored NPSG/titration. Maybe you would benefit from ASV. But SH can neither prove nor disprove that fact. An open-airway apnea, as scored by a home machine and reported by home software is not clinically significant by nature.

I agree with earlier posters who pointed out the slippery nature of Complex Sleep Apnea. It is notoriously difficult to document when, as has been said, it can be very bad one night and virtually nonexistent the next. That can require some crafty reinterpretation of data in order to quality a patient to get ASV paid for even when response to it has proved to the doc that ASV is the thing.

Maybe getting a sleep test in a center that is located a mile high in New Mexico or somewhere would do the trick for scaring up some documented pressure-induced/altitude-induced centrals?

[Bons]

The sleep lab tech knows when you are awake or asleep and scores the report accordingly. On the previous titration tests were your centrals separate or in clusters?

I have complex apnea. I had to have several months of proven data from failed bipap before I could get an ASV.

To show how random sleep lab nights can go: after 6 years I was titrated for a new ASV. The tech started me out on a minEpap of 5 and never had to change the settings all night. My AHI was less than one. For 6 years I'd had a min EPAP of 10. Go figure. But insurance approved the new ASV thanks to earlier documentation.

[Chevie]

The sleep lab tech knows when you are awake or asleep

More technically, the EEG knows when you are awake or asleep. The tech looks at the event and then at the corresponding point on the EEG to score the event as obstructive, central or not an event.

[jnk...]

The EEG . . . It's alive. . . . It's ALIIIIIIIIIVE!!!!

[BlackSpinner]

, the EEG knows when you are awake or asleep

SANTA!!!!!