AASM invites public comment on apnea testing guidelines

[anakinskywalker]

Hello everyone, There is a short window until Sept. 7th to post public comment on a draft clinical practice guideline for the diagnostic testing of obstructive sleep apnea in adults. Check out the American Academy of Sleep Medicine website notice http://www.aasmnet.org/articles.aspx?id=6447
I stumbled upon this invitation to comment on the testing guidelines when I was trying to get information about what, in fact, the testing guidelines are. I've been struggling over the last several years with having been steered by my medical provider and insurer to the most expensive testing route of 2 full-night PSG with manual titration on the second night. It cost so much (nearly $6000) even after the insurance "discount" because, like a lot of older Americans who have lost their employer-provided insurance, I was paying for my own insurance which had a high 10K deductible. The high cost of sleep testing nearly killed me since I was then unable to afford the surgery I needed for a co-morbid condition until nearly 3 years later when I was able to purchase a few months of better insurance (after the Affordable Care Act prohibition of the pre-existing condition rules went into effect). I provided my comment to AASM yesterday encouraging them to alter the guidelines to encourage more affordable home-based testing and titration, and single split-night lab testing, and to provide better gender-specific testing parameters for the AHI-cutoff for split night testing. Although the guidelines only address the diagnostic testing, I also provided comments that the labs should provide better education for first-time CPAP purchasers by informing patients that purchasing without insurance is often much cheaper as this is not well-known to first time users. I also requested that the AASM recognize the particular co-morbid condition that I had, a para-esophageal hernia (PEH) as deserving of more expedited OSA treatment and testing. PEH is directly impacted by obstructive sleep apnea because the negative intrathoracic pressure that occurs during apneas cause a PEH to enlarge and eventually become life-threatening. A PEH can only be corrected by complex surgery by an surgeon experienced in foregut/esophageal disease. Currently the guidelines don't even mention any hiatal or diaphragmatic hernia/gastroesophageal problems, and yet the occurrence of such conditions is not uncommon in sleep apnea patients. I would encourage everyone on cpaptalk to consider providing comments on the new guidelines. Thanks, Anakinskywalker.