Itamar Medical Watch-PAT 100

[roster]

Portable Monitoring and Autotitration versus Polysomnography for the Diagnosis and Treatment of Sleep Apnea Volume : 31
Issue : 10
Pages : 1423-1431

Richard B. Berry, MD1,2; Gilbert Hill, BS1; Linda Thompson, RN1; Valorea McLaurin, RPsgT1

1Malcom Randall VAMC, Gainesville, FL; 2Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, FL




Study Objectives:

To compare a clinical pathway using portable monitoring (PM) for diagnosis and unattended autotitrating positive airway pressure (APAP) for selecting an effective continuous positive airway pressure (CPAP) with another pathway using polysomnography (PSG) for diagnosis and treatment of obstructive sleep apnea (OSA).

Design:

Randomized parallel group

Setting:

Veterans Administration Medical Center

Patients:

106 patients with daytime sleepiness and a high likelihood of having OSA

Measurements and Results:

The AHI in the PM-APAP group was 29.2 ± 2.3/h and in the PSG group was 36.8 ± 4.8/h (P = NS). Patients with an AHI ≥ 5 were offered CPAP treatment. Those accepting treatment (PM-APAP 45, PSG 43) were begun on CPAP using identical devices at similar mean pressures (11.2 ± 0.4 versus 10.9 ± 0.5 cm H2O). At a clinic visit 6 weeks after starting CPAP, 40 patients in the PM-APAP group (78.4% of those with OSA and 88.8% started on CPAP) and 39 in the PSG arm (81.2% of those with OSA and 90.6% of those started on CPAP) were using CPAP treatment (P = NS). The mean nightly adherence (PM-APAP: 5.20 ± 0.28 versus PSG: 5.25 ± 0.38 h/night), decrease in Epworth Sleepiness Scale score (—6.50 ± 0.71 versus —6.97 ± 0.73), improvement in the global Functional Outcome of Sleep Questionnaire score (3.10 ± 0.05 versus 3.31 ± 0.52), and CPAP satisfaction did not differ between the groups.

Conclusions:

A clinical pathway utilizing PM and APAP titration resulted in CPAP adherence and clinical outcomes similar to one using PSG.

http://www.journalsleep.org/ViewAbstrac ... ionid=3677


This topic came up at an AWAKE meeting this week. The sleep doc making a presentation was happy to discuss it. I fully expected him to defend PSGs and his lab. I was surprised when he said we need to use PMs because we don't have enough beds in the country to do all the diagnosis that needs to be done.

[StillAnotherGuest]

Hmmm, not a lot of women in the study (PM arm only had 7 out of 53). I wonder why that was. Perhaps they couldn't make inclusion criteria even if they had moderate to severe disease (didn't have "loud" snoring or witnessed apnea). As far as overall diagnosis and treatment, that might not be a bad thing. Women, especially around the perimenopausal age, tend to have a lot of sleep initiation/maintenance issues (age was about 52 in the PM arm) so perhaps as a target group, women in general shouldn't be tossed into PM without a careful H&P. And depending on the device, UARS can be missed entirely.

In addition to what I previously noted, they also excluded symptoms of RLS (I suppose that would imply they don't want PLM cases)(although if you're slick, you may be able to pick up PLMs with PAT), a-blockers (may not be an absolute excluder, either), and anybody without a normal heart rhythm (so all you a-fibbers are out).

SAG does not have a problem with Portable Testing. He did one-channel testing for OSA for 10 years (widespread PSG capability hasn't been around that long)(and SAG started work when he was 4)(so that makes him only 36).

However, SAG does have issue if PM is being used as a surgery screener (yeah, that's gonna be a BFP), if the inclusion/exclusion algorithm is poor or ill-defined and/or if the PM staff drive around in a pickup truck that had previously been used to bring produce to the Farmer's Market.

SAG

[jskinner]

DME MACs Change LCDs to Include Watch-PAT Coverage

http://www.sleepreviewmag.com/sleep_rep ... -07_01.asp

[roster]

DME MACs Change LCDs to Include Watch-PAT Coverage

http://www.sleepreviewmag.com/sleep_rep ... -07_01.asp

Thanks James. That's a little bit of good news for some of the tens of millions of people with undiagnosed sleep apnea.

[SLEEPMONITORING]

WE HAVE A FEW ATCH PAT 100 BRAND NEW IN THE BOX WITH ALL SOFTWARE PLEASE CALL SAM 310-989-4123

[GumbyCT]

WE HAVE A FEW ATCH PAT 100 BRAND NEW IN THE BOX WITH ALL SOFTWARE PLEASE CALL SAM 310-989-4123

He doesn't say how much. But if anyone can get a price out of Sam - post it here.

[jskinner]

He doesn't say how much. But if anyone can get a price out of Sam - post it here.

I almost bought one of these devices back just to test family and friends. The disappointing part is that the finger tip device needs to be replaced for each use. Its about $50.

Still I think its a great device for labs and DMEs

[Unknown]

Unknown message

[Janknitz]

Kaiser here in Northern California uses the Watch Pat 100 exclusively for sleep apnea testing. They seem quite confident in it's accuracy, and they have a vested interest in the outcome of such testing because as both the insurer and the medical care provider they save money when the long-term effects of untreated sleep apnea are effectively treated or risks are decreased with appropriate therapy.

Kaiser also acts as its own DME provider (with Crapria as the supplier), so they certainly don't want to be supplying unnecessary machines for falsely positive PSG's. They must have some confidence in the accuracy of the testing.

I am amazed at the sheer numbers of people they are testing and treating each week by my local Kaiser sleep clinic. They have a dedicated sleep lab staff to read the tests, provide patient education and support, and monitor treatment efficacy as well as compliance.

It's not perfect, and I am generally NOT a fan of Kaiser's "big box" approach to medical care, but I think this is a situation where it works well for most OA patients. I'm not so sure how well this would work for someone with very complex issues, PLMD, etc, but if they reserved in lab testing for those individuals (I'm not sure what Kaiser does in those cases) it makes perfect sense to use technology like this home test for the majority. Personally, I very much preferred testing at home in my normal sleeping conditions to the hell some people experience in sleep labs.

[M.D.Hosehead]

This story has been fascinating. It wouldn't change anything for those of us who have been diagnosed and are already using xpap. Wouldn't it be interesting to see what would happen if a cheap, valid method were found for diagnosing and following up sleep apnea. Then as Rooster suggests, let WalMart/BestBuy sell the machines without prescription, and Consumer Reports evaluate them.

But I remain skeptical. It seems unlikely that sleep stages and apneas can be detected from blood flow in a finger. The company won't say how they do it, except to claim they've developed an algorithm that produces valid, reliable diagnoses. I can think of a lot of reasons it shouldn't work, and I'm waiting to see their results replicated by a skeptical researcher with no conflict of interest. Maybe someone here can point to that kind of publication.

[roster]

Speaking only of OSA, which is highly prevalent in our population, one thing I am interested in is seeing a cheap, easy, convenient, accurate way to evaluate tens of millions. What Itamar has on their website about Watch-PAT is very impressive.

Note that some doctors claim, with a ten-minute interview and a quick physical examination of jaw structure, teeth, tongue and soft palate, they can evaluate for OSA with a high degree of accuracy. Combine this type of examination with a Watch-PAT study and the accuracy should be very high.

As with most things in medicine (and life) the cost, time, inconvenience, and patient reluctance need to be overcome. There also seems to be some doctor reluctance to recognize the prevalence of OSA and diagnose and treat it.

[jskinner]

But I remain skeptical. It seems unlikely that sleep stages and apneas can be detected from blood flow in a finger. The company won't say how they do it, except to claim they've developed an algorithm that produces valid, reliable diagnoses.

The Watch-PAT uses a combination of peripheral arterial tone (PAT), pulse rate, actigraphy and oximetry. There has been quite a bit of validation on this device. I guess you take a look in PubMed

[M.D.Hosehead]

But I remain skeptical. It seems unlikely that sleep stages and apneas can be detected from blood flow in a finger. The company won't say how they do it, except to claim they've developed an algorithm that produces valid, reliable diagnoses.

The Watch-PAT uses a combination of peripheral arterial tone (PAT), pulse rate, actigraphy and oximetry. There has been quite a bit of validation on this device. I guess you take a look in PubMed

I did that, J. But you can't tell how many of the studies were paid for by the manufacturer or whether the authors are paid by the manufacturer as consultants. If it works, the results will be replicated by others. That would be great.

[chunkyfrog]

Watch-Pat might not be a favorite of DME's and especially sleep labs.
I can see it used to best effect by PSP's and even HMO's
--as a cost-cutting measure.
That would be logical--hope the insurance co's can't screw with the data.

[Janknitz]

I can see it used to best effect by PSP's and even HMO's
--as a cost-cutting measure.
That would be logical--hope the insurance co's can't screw with the data

.

HMO's and insurers benefit by identifying and treating SA--it is preventive medicine. Treating SA is expensive, but far less expensive than the downstream effects of untreated SA (obesity, diabetes with all it's problems, heart disease, stroke).

DME's should like it because they could be the providers of the test.

Bad sleep labs won't like the competition, good sleep labs may use it to save money and offer the more expensive in lab testing only for people with more complex issues.