Home Sleep Testing v Sleep Center Testing

Here is another interesting article.

It discusses whether home sleep testing will drive sleep centers out of business. It looks like a home study followed by a trial period of an auto CPAP may give just as good results as an inpatient sleep center polysomnogram.

Just something to think about.

http://pulmccm.org/2013/outpatient-pulm ... dard-care/

JDS74 wrote:Here is another interesting article.

It discusses whether home sleep testing will drive sleep centers out of business. It looks like a home study followed by a trial period of an auto CPAP may give just as good results as an inpatient sleep center polysomnogram.

Just something to think about.

http://pulmccm.org/2013/outpatient-pulm ... dard-care/

Where I was tested home studies are done first and if you fail them (ie it shows nothing or is confusing or the issues continue after cpap) only then are you sent to a full sleep study. A home sleep study does not rule OUT sleep issues, it diagnosis plain vanilla OSA.

If you are a self paying parient, the economics look like this:

1) Home sleep Study $100
2) Sleep Center Study $2500
3) CPAP Machine $800 - $1600

Total cost $3400 - $4200

Or

1) Home Sleep Study $100
2) PR autoSV $2700

Total cost $2800

What would you choose?

The insurance companies / Medicare etc. can do the same arithmetic.
With 90% or so of apnea patients having plain OSA, sleep centers will lose almost all of their revenue if the business model changes as suggested in the article.

The result looks like Sleep Centers will be out of business.

BTW the autoSV can be configured to do straight CPAP, Bi-level CPAP, or auto servo all in the same machine.

Unfortunately, as a self pay patient, I got charged $600 at a hospital for a sleep study that was pretty worthless other than to tell my I had apnea. Ok, that was valuable information but other than that, that is all I got from it.

Know what I now know, I would have come to this forum and purchased a machine directly from either a seller here or on Craig's List without a study since the doctor was pretty sure I had it.

49er

I can see something like this could make home studies better.
http://www.gizmag.com/hexoskin-sensor-t ... ics/29098/

JDS74 wrote:If you are a self paying parient, the economics look like this:

1) Home sleep Study $100
2) Sleep Center Study $2500
3) CPAP Machine $800 - $1600

Total cost $3400 - $4200

Or

1) Home Sleep Study $100
2) PR autoSV $2700

Total cost $2800

What would you choose?

The insurance companies / Medicare etc. can do the same arithmetic.
With 90% or so of apnea patients having plain OSA, sleep centers will lose almost all of their revenue if the business model changes as suggested in the article.

The result looks like Sleep Centers will be out of business.

BTW the autoSV can be configured to do straight CPAP, Bi-level CPAP, or auto servo all in the same machine.

Why go for the really expensive SV?

What usually should happen is you RENT one for a month to find out what your titration needs are and buy what you need. If you have Vanilla OSA with pressure needs of 7 - 12 there is no need to sink $2700 into a machine.

Kaiser does home testing and home titration with an auto machine. It works for most people.

My insurance defaults to home studies. However, they also had a number of criteria that would warrant skipping the home study and going directly to a lab study. Skipping the home study step required justification by my doctor and prior approval by the company. I was able to meet the criteria, so I was able to start with the lab test. This was fortunate since the lab not only found signs of mild OSA (or more likely UARS), but they also diagnosed me with a significant number of PLMs that would not have been picked up by a home study. If I had started with just the home study, I am not sure whether I would have been approved for the next step.

Steve

Blackspinne

The point is even with the expensive ASV machine, it is stiil cheaper than an over night sleep study / titration. Dropping to an auto bi-level machine makes the price difference even worse with the minimum savings pushing $2000 and more.

The end result is sleep centers are at a huge disadvantage in costs.

The positive value of getting an ASV machine for everyone is that the price differential from lower capable machines will decrease and unless you need a ventilator such as the Trilogy, the ASV can be configured to meet your needs. So 30 days on the ASV and it gets set to what you need. If those needs change, it gets reset and off you go.

I agree that insurance will not be likely to select that solution but folks who self pay should long and hard at that solution.

RLS & PLMD are different issues from SDB issues although there are connections.

Blackspinner wrote: A home sleep study does not rule OUT sleep issues, it diagnosis plain vanilla OSA.

I had a home study two years ago...on initial dx. The device had a chest strap to detect respiratory effort and a nasal cannula to detect periods of no breathing (apnea). So an apnea with no respiratory effort was deemed a central apnea. That goes a little beyond vanilla OSA. And this data was acceptable to my sleep Doc.
J

RLS & PLMD are different issues from SDB issues although there are connections.

My point is that not all initial complaints about sleep problems to a doctor need be a form of SDB. Sleep studies are used to diagnose more than just the OSA that a home study is designed to detect.

Had my physician gone with just the home study, I would not have the PLM/RLS diagnosis and treatment. The PLMs were responsible for at least half of my sleep problems.

Rustsmith wrote:

RLS & PLMD are different issues from SDB issues although there are connections.

My point is that not all initial complaints about sleep problems to a doctor need be a form of SDB. Sleep studies are used to diagnose more than just the OSA that a home study is designed to detect.

Had my physician gone with just the home study, I would not have the PLM/RLS diagnosis and treatment. The PLMs were responsible for at least half of my sleep problems.

If the proper protocols were followed your home study would have been followed by a full sleep study because either it didn't show what made you tired (hi AHI) or because cpap therapy wasn't helping.

I wonder how much trial and error it takes until your average patient simply walks away in disgust.
Some of the multiple hurdles placed before patients seem to have that result, if not the express intent.

I am a member of Kaiser. I did the home study and
It showed I had very mild Apnea. In fact the sleep Doctor
said it showed normal. I insisted it was wrong and
asked for a all night in house hospital sleep study. Well
within days the doctor was calling me and telling me I
had severe sleep apnea !! She was surprised at the results!!
So if your insurance pays for it always get a hospital or clinic
sleep study !!