self titrating an ASV

[ajack]

you have the resmed 10?
this is the s9 clinical titration, it may give the basics, including pages 28+ and 41
https://www.resmed.com/us/dam/documents ... lo_eng.pdf

[Guest]

[quote="ajack"]you have the resmed 10?
this is the s9 clinical titration, it may give the basics, including pages 28+ and 41
/quote]
deleted url so i can post


thanks
i may have seen the s9 document
will save a copy and read it to be sure that i have seen it now

[klv329]

If you are considering a backup ASV machine, as many do:

This fellow may have some new unused resmed aircurve 10 asv for sale and he is reliable. He had a 2017 model, not sure if he still has 2017 models.

https://raleigh.craigslist.org/hab/6116831598.html


This one has 415 or so hours on it...2015 model.
https://maine.craigslist.org/hab/6096409597.html

[TASmart]

I think your battle is that if you look at the numbers of people who fail at self titrating and treating SDB and compare that to the numbers who fail with proper support from well trained personnel the odds favor the sleep study approach. Insurance companies are all abut playing the odds. I think the odds greatly favor the approach that the insurance companies take. after all, they do make a pretty good profit, so they know something about playing the game.

[Goofproof]

I think your battle is that if you look at the numbers of people who fail at self titrating and treating SDB and compare that to the numbers who fail with proper support from well trained personnel the odds favor the sleep study approach. Insurance companies are all abut playing the odds. I think the odds greatly favor the approach that the insurance companies take. after all, they do make a pretty good profit, so they know something about playing the game.

I can't subscribe to that thinking, many of the 50% that quit XPAP or Fail are patients that have Sleep Studies, as for as well trained personnel, I don't think enough of them are qualified at their tasks, this applies to many out there, in all parts of our nations workforce all jobs. Too many people going thru the motions at work with no drive to be the best at their jobs.

There is too much variation in testing, I also consider home testing a joke, much worse than a Sleep Lab.

For (normal people), that really care about treating their SA, using a machine and the software to read the full data, is the best way to treat SA for over 80% of patients, that don't fall into the weird class, with special needs. If plan A doesn't work, try plan B a full BLOWN (pun intended) Lab Sleep Study).

For (Normal People) I mean people willing to learn about SA, and have the ability to Reason and follow a path step by step without jumping off the path with faulty reasoning. I realize this is not possible for everyone. Many here seem to get the idea they need the most costly machines for good treatment, for many it just makes for more effort and worry (Problems).

I prefer my treatment to solve the problem, not give me more to obsess over. My old "Tanks", don't measure CA's just AHI, time of events in seconds, Leak rate, Pressure, that's all I need to obsess over, I fix what's needed any live my life, I don't want Sleep Apnea to be my life. Jim

[TASmart]

Except that a home test cannot/does not determine if someone is awake or asleep. You need to know the actual sleep state to determine what is going on, especially with centrals.

[palerider]

I think your battle is that if you look at the numbers of people who fail at self titrating and treating SDB and compare that to the numbers who fail with proper support from well trained personnel the odds favor the sleep study approach.

where are these "numbers"?

I'll bet that the vast majority of people here have been failed by the sleep studies and trained personnel, else they wouldn't have felt the need to find a support forum.

[palerider]

Except that a home test cannot/does not determine if someone is awake or asleep. You need to know the actual sleep state to determine what is going on, especially with centrals.

you shouldn't make blanket statements, some home tests record eeg.

[TASmart]

IF your home test does not include an eeg then it cannot tell if you are asleep or awake.

[palerider]

IF your home test does not include an eeg then it cannot tell if you are asleep or awake.

you do realize that typical awake breathing and typical asleep breathing look different on the flow trace, right?

[TASmart]

Yes I am aware of that. I take it you are a believer that home studies are as effective and accurate as clinic based studies?

[palerider]

Yes I am aware of that. I take it you are a believer that home studies are as effective and accurate as clinic based studies?

I'm a believer that sleep studies as a whole aren't very accurate.

anybody that's spent any time at all studying sleep reports realizes that sleep varies from hour to hour, and night to night. maybe a fully wired up inlab study catches you on a good night, or maybe they catch you on a bad night, or maybe your sleep is adverse in the foreign environment... who knows,

how many people spend a week in a sleep lab to get a decent average reading? nobody.

"home studies" encompass a wide variety of different machines that have different capabilities, some are much more thorough, providing more data than others. you cannot simply lump them all into a bucket, and then throw them out.

[TASmart]

Seems like a fair enough assessment. However, given that, what should be done to assess sleep disordered breathing? I think that while not perfect, it is the best we have. If you look back to the genesis of this thread, the discussion on sleep lab stated because the OP believes that sleep studies in laboratories are useless (not useful). so where does that leave the state of the science? Sure it is imperfect systems on imperfect non-standardized subjects. The goal of in lab or out of lab studies are to best identify the type and solution to SDB on a population wide basis. an additional requirement is that we manage to provide that on the lowest aggregate cost for the population. And overall, I think the sleep lab option provides that. Not for each individual, but on the population that insurance companies work with.

Anyway, just my thoughts. I know you will feel free to disagree.

[palerider]

Seems like a fair enough assessment. However, given that, what should be done to assess sleep disordered breathing? I think that while not perfect, it is the best we have. If you look back to the genesis of this thread, the discussion on sleep lab stated because the OP believes that sleep studies in laboratories are useless (not useful). so where does that leave the state of the science? Sure it is imperfect systems on imperfect non-standardized subjects. The goal of in lab or out of lab studies are to best identify the type and solution to SDB on a population wide basis. an additional requirement is that we manage to provide that on the lowest aggregate cost for the population. And overall, I think the sleep lab option provides that. Not for each individual, but on the population that insurance companies work with.

Anyway, just my thoughts. I know you will feel free to disagree.

for the vast majority, a home test is sufficient, and then an auto titrating machine, with a little management will get them where they need to be, with much less trouble for the patient, and much less expense, no matter who pays.

for a minority of cases, an in lab study can identify uncommon modalities, albeit at a much greater expense, both of time and money.

[TASmart]

From Sleep, a peer reviewed journal, which concluded just what my analysis of the population cost of type of testing:

Sleep. 2011 Jun 1;34(6):695-709. doi: 10.5665/SLEEP.1030.
An integrated health-economic analysis of diagnostic and therapeutic strategies in the treatment of moderate-to-severe obstructive sleep apnea.
Pietzsch JB1, Garner A, Cipriano LE, Linehan JH.
Author information


Abstract
STUDY OBJECTIVES:
Obstructive sleep apnea (OSA) is a common disorder associated with substantially increased cardiovascular risks, reduced quality of life, and increased risk of motor vehicle collisions due to daytime sleepiness. This study evaluates the cost-effectiveness of three commonly used diagnostic strategies (full-night polysomnography, split-night polysomnography, unattended portable home-monitoring) in conjunction with continuous positive airway pressure (CPAP) therapy in patients with moderate-to-severe OSA.
DESIGN:
A Markov model was created to compare costs and effectiveness of different diagnostic and therapeutic strategies over a 10-year interval and the expected lifetime of the patient. The primary measure of cost-effectiveness was incremental cost per quality-adjusted life year (QALY) gained.
PATIENTS OR PARTICIPANTS:
Baseline computations were performed for a hypothetical average cohort of 50-year-old males with a 50% pretest probability of having moderate-to-severe OSA (apnea-hypopnea index [AHI] ≥ 15 events per hour).
MEASUREMENTS AND RESULTS:
For a patient with moderate-to-severe OSA, CPAP therapy has an incremental cost-effectiveness ratio (ICER) of $15,915 per QALY gained for the lifetime horizon. Over the lifetime horizon in a population with 50% prevalence of OSA, full-night polysomnography in conjunction with CPAP therapy is the most economically efficient strategy at any willingness-to-pay greater than $17,131 per-QALY gained because it dominates all other strategies in comparative analysis.
CONCLUSIONS:
Full-night polysomnography (PSG) is cost-effective and is the preferred diagnostic strategy for adults suspected to have moderate-to-severe OSA when all diagnostic options are available. Split-night PSG and unattended home monitoring can be considered cost-effective alternatives when full-night PSG is not available.
KEYWORDS:
Markov model; Sleep apnea; comparative effectiveness; continuous positive airway pressure; health-economics; obstructive
Comment in
The demise of portable monitoring to diagnose OSA? Not so fast! [Sleep. 2011]
PMID: 21629357 PMCID: PMC3098944 DOI: 10.5665/SLEEP.1030
[Indexed for MEDLINE] Free PMC Article

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