Any One Hear of This ????

[Slinky]

From a thread at apneasupport.com

I've been reading some of the posts about peoples sleep studies experiences. It seems to me that many sleep study clinics are about 20 years behind the times in terms of technology.
When I had my sleep study done on April 1, 2009, it was at the Minneapolis Veterans medical center. My dad had his done at another local hospital a few years earlier and told me to expect a "plethora" of wires to be attached to my head & chest.
I was surprised when all they needed at the Veterans medical center to do the sleep study was an electrode attached to my left index finger. They told me "This one wire can read your heartbeat, pulse, ekg, determine rem sleep, how many times you'll awaken, then fall asleep, EVERYTHING we need to know about your sleep habbits and wether or not you have sleep apnea."
The test went so smoothly and, they had the complete results the next day about 30 minutes after I was awakened.
An hour after that, i was in a small class, learning how to use my new CPAP machine.
Also, when i mentioned that other sleep centers attached wires to peoples head & chest, one of the attendants said "the Veterans medical center is the countries leading sleep study research facility. most other sleep centers are about 25 years behind the times when it comes to our technology."
And, after reading some of the posts on this site, I believe him.

[Kiralynx]

Dunno, but the date of the "sleep study" would cause me to wonder about it....

[M.D.Hosehead]

My skeptic antennae are humming.

Detect REM in a fingertip? Observe apnea in a fingertip?

G'wan pull the other one.

[Janknitz]

MD, put your skeptic antennae away. Kaiser uses a similar system--goes on two fingers (and it's done at home) and it records 9 channels of info--enough to satisfy Medicare which initially rejected home studies but now allows them if they meet certain criteria.

Darn but I cannot remember the name of the machine they used to do the testing (Israeli made), but it's high technology and is legit.

Kaiser does only home studies, but I never would have tolerated an in-clinic study if that was what was available to me, so I'm actually grateful for their money pinching ways. I'd still be out there untreated and desatting in the low 70's or worse every night. I think it makes a lot of sense to test in your own bed and sleeping conditions.

[Slinky]

Okay, JanKnitz, your assignment for the week is to find out the name of that Kaiser two finger PSG and report back to us.

And, no, this post will NOT self-destruct in 30 seconds. Its gonna hang around here as a reminder to you of your assignment.

[NotMuffy]

WatchPAT.

NM

[nosenabook]

I agree, M.D., that sounds too good to be true. But I have to believe Janknitz, she wouldn't lie to us!
The only thing missing is the video, and maybe leg movements.
I was so tickled by all my electrodes, I am sad to find they are not cutting edge.

Except how cool is that?

We need more of them, lots more.
One place to find WatchPAT is:
http://www.sleepreviewmag.com/sleep_rep ... -17_08.asp
Thanks, NotMuffy

[elena88]

how in the world can they detect central apnea without the chest band?

centrals are included in your ahi correct?

I only slept an hour in my study, but the wires didnt bother me, it was the five trips to the head!

[rested gal]

"NotMuffy" wrote the name of the device...the WatchPAT.

http://www.itamar-medical.com/Product.asp?pid=3006

See the marketing brag about:
"The American Medical Association (AMA) has awarded Itamar-Medical’s WatchPAT™ device a Category III CPT code!"

CPT stands for "Current Procedural Terminology." (whatever THAT means! LOL!!)

For definitions of type I, II, III, and IV sleep studies:
http://www.clevemed.com/terms/type-1_ty ... _CMS.shtml

Definitions according to Center for Medicare & Medicaid Services (CMS) Guidelines

Type I –
Attended studies (sleep studies that are performed with the oversight of a sleep technologist) with full sleep staging (sleep staging monitors the transition through the sleep stages, traditionally with the use of EEG electrodes that monitor the brain). Type I devices must include the following channels:
EEG
EOG
ECG/Heart rate
Chin EMG
Limb EMG
Respiratory effort at thorax and abdomen
Air Flow from nasal canula thermistor and/or X-Flow (AASM recommends RIP technology
Pulse Oximetry
Additional channels for CPAP/BiPap levels, CO2, pH, pressure, etc.
(CPT #95810 Baseline PSG, 95805 MSLT, 95811 Titration)

Type II –
Home sleep test (HST) with Type II portable monitor, unattended (sleep studies that are performed without the oversight of a sleep technologist), with a minimum of 7 channels. Type II devices must include the following channels:
EEG
EOG
ECG/heart rate
EMG
Airflow
Respiratory effort
Oxygen saturation
(HCPCS #G0398)

Type III –
Home sleep test (HST) with Type III portable monitor, unattended with a minimum of 4 channels. Type III devices must include the following channels:
2 respiratory movement/airflow
1 ECG/heart rate
1 oxygen saturation
(HCPCS #G0399, CPT 95806)

Type IV –
Home sleep test (HST) with Type IV portable monitor, unattended; minimum of 3 channels. Type IV devices must allow channels that allow direct calculation of an AHI or RDI as the result of measuring airflow or thoracoabdominal movement. Alternatively devices that record other information to derive AHI or RDI must be approved by CMS through the review of published peer-reviewed medical literature. (HCPCS #G0400)


Definitions according to American Academy of Sleep Medicine (AASM) Guidelines

Type I -
Monitoring devices perform in-laboratory, technician-attended, overnight polysomnography (PSG) and are discussed separately. (CPT #95810 Baseline PSG Study, CPT #95805 MSLT Study and CPT #95811 Titration Study (CPAP))

Type II –
Monitoring devices can perform full PSG outside of the laboratory. The major difference from type 1 devices is that a technologist is not present. These devices are called comprehensive portable devices. (CPT #95807)

Type III –
Monitoring devices do not record the signals needed to determine sleep stages or sleep disruption. Typically channels include:
Four physiologic variables are measured including:
Two respiratory variables (eg, respiratory movement and airflow)
Cardiac variable (eg, heart rate or an electrocardiogram)
Arterial oxygen saturation
Some devices may have other signals including a monitor to record snoring, detect light, or a means to determine the body position.
(CPT #95806)

Type IV –
These devices are called continuous single or dual bioparameter devices. Monitoring devices record one or two variables and can be used without a technician. Typically channels include:
Arterial oxygen saturation
Airflow

[Emilia]

This is all very interesting. Based on the quote in the initial post, I went to the Minneapolis Veterans Medical Center website to see what info they offered on their sleep study facilities. I finally found the sleep study center in the Mental Health Dept. (!!).... and the said that they order all sleep studies done at off site centers; however, the VA docs do the analysis of the data sent back to them from those off site labs. So...it seems that since that person's study in 4/09, they no longer do the sleep study at the MVMC. As a result, there was no information on the type of equipment used or what off site labs they might use.

[M.D.Hosehead]

Argee, you're one of my main heroes. Thanks so much digging that out.

From reading Wikipedia, Google, and following the links on the Itmar company website, I gather:

The device is worn on the wrist and fingertip. It measures physical motion, O2 sat, and pulsations in the volume of the finger due to blood flow. It doesn't directly observe eye movements, leg movements, thoracic movements, airflow, EEG sleep stage, ECG and so on. I gather that airway obstruction, and indices such as AHI are calculated by analyzing the record of just those three variables (movements of wrist/arm, O2, and changes in finger volume) according to a proprietary algorithm.

It still seems incredible, and they won't tell how they do it, but the correlation with PSG diagnosis seems to be good enough, according to peer-reviewed studies, to convince the relevant AMA committee. ( I suppose the WatchPat is approved as a Type IV--alternative device that records other information). I haven't dug out how many of those studies are paid for by the Itmar company.

If the findings hold up, it would seem to make it easier to identify people with Sleep Apnea. It also seems like sleep labs would still be needed for titration studies. At least so far. I'm skeptical that there's any money to be saved, though. Even though the diagnostic procedure may cost less, if more patients are diagnosed, expenditures for treatment have to go up.


Janknitz. thanks for cooling my skeptic antennae.

Thanks, Argee, NM, Nosenabook, I've learned something new.

But I never put my skeptic antennae away; there's too much BS around.

[Slinky]

Ahhh, my heroine, RestedGal, strikes again to clear the air and inform the uninformed. (((hugs))), yet again, RG!

[rested gal]

I never put my skeptic antennae away;

I don't either.

there's too much BS around.

"Argee" (took me awhile! lol) agrees.

[torontoCPAPguy]

Having spoken to my respirologist who is also a sleep specialist, I am of the opinion that only the first, a Type 1 sleep study including EEG is of sufficient clinical value to determine a course of treatment. How can one make a decision on a going forward basis without knowing what amounts and level of sleep a patient has experienced? Not saying that the others are totally useless, but they appear to be information that the patient himself/herself can generally accumulate over time for a truly valuable clinical record. Having reached the point where my AHI is sometimes 0.0 with zero events appearing and excepting the fact that I am still not feeling fully rested in the AM and need more investigation, the only way I can move forward is by knowing the quality of the sleep that I AM getting and that takes a valid EEG I believe. That, matched to my SaO2 desats would be very valuable clinical information and could be the last step in the puzzle of why I appear not to be getting a solid night of sleep. I vaguely recall waking and turning during the night.......... possible the result of those oxygen desats and my body telling me to wake up and breathe more deeply.

My next step after another few weeks of reading my SaO2 nightly and laying it alongside any events I may be having from my S9 Auto data... I am going to either infuse 2 or 3L of O2 myself into the airflow; or I am going to first get a Type 1 Sleep Study, split perhaps between no O2 and a small amount of infused O2 to see what the difference is in quality of sleep as measured by an EEG.

I have a feeling that the sleep clinic may be just as interested in the results as I am.

Always remember that the object is to get your numbers down and then adjust whatever needs adjusting to get the best sleep that you can, not necessarily in that order.

I have been though every one of the best doctors in town for every part of my body. They have checked me from the bottom up and from the top down and I have had several sleep studies thus far..... and I have never even heard talk of a Type 1 sleep study (which we should all be insisiting on) that takes a single wire to the fingertip. I would be asking if they would mind pulling my small finger to see what happens.

[Julie]

I have a feeling that while the tests (1 or 2 wire) say they do all those things and chew gum, in fact I think they may just be measuring 02 levels and a couple of other things, but extrapolating statistical results for all the other parameters from them, e.g. if your 02 is at 90%, then three other 'answers' statistically will be within blah blah range (expressed in whatever measurements are appropriate for the particular parameter). It's like saying so and so elixir will cure everything, but it's not that there are 4,000 diff. chemicals in the stuff, just that alcohol does pretty much make everything feel good!