Medical Center launches innovative pilot program to screen patients for Obstructive Sleep Apnea at home

Enough that in 2017 the AASM "recommends that polysomnography, rather than home sleep apnea testing, be used for the diagnosis of obstructive sleep apnea in patients with significant cardiorespiratory disease;"-- https://aasm.org/aasm-publishes-new-gui ... eep-apnea/

Furthermore, as a 2018 presentation made clear about HSAT (the abbreviation now used by many to clarify that sleep itself is not actually measured):

Respected Chicago dude wrote:
. . . Home Sleep Apnea Testing (HSAT)

• Best for diagnosis in high suspicion patients
• Does not rule out disease
• Best device is not known
• Not as simple as it looks

. . . 2007 Recommendations from the AASM on HSAT for OSA

. . . • High pretest probability of moderate to severe OSA
– Without comorbid medical conditions or suspected comorbid sleep disorders
. . . • Not recommended for general screening of asymptomatic patients . . .

(Underlining is in the original)

From a 2018 slide presentation: Technologies for the Diagnosis and Monitoring of Sleep Disordered Breathing, Neil Freedman, MD. -- https://www.fda.gov/media/112614/download

So the confusion by payors is based on the misunderstanding that the high value of HST for getting obviously symptomatic OSA patients to PAP quickly also means that HST must have some value in screening to rule out disease. This is not the case. It is a serious point with serious life-and-death consequences. Especially is this the case for people with high likelihood of central issues or sleep issues beyond simple obstruction of any sort, which HST is not designed to help find.

I get that their, ahem, heart may be in the right place, but pretending HST screens in a way that it rules out any benefit from PAP for any given patient is just wrong, wrong, wrong. In my not-so-humble opinion.

End of my rant. In this thread, anyway.

End of my rant. In this thread, anyway.

Jeff, you're giving me the last word????

Don't forget AASM has a vested interest in requiring in lab sleep tests, so I wouldn't expect them to take another position.

The reality is that many people will NOT undergo in lab sleep tests because of the out of pocket expense , because they cannot stand the idea of being wired up and watched while they sleep--or don't sleep (raising my hand here!), because they don't have insurance at all, because they have limited geographic or economic access to in lab testing, because they are embarrassed, because they fear being ridiculed or shamed (often because they are overweight).

When I was referred to the sleep clinic and acquiesced to go (my husband asked me to) it was with every intention of refusing a sleep test because I thought it would be in a sleep lab and there was NO way I was going to do that. I would still be un-diagnosed (and more importantly un-treated!) today if that was the only option. I only agreed to the home test when I saw the Watch Pat and how unobtrusive it was.

Further, the Kaiser staff could test 10-12 people in one night without a great expenditure of resources or staff. That means that more people got tested, diagnosed, and ultimately treated (and yes, it saved Kaiser a whole bunch of money on both sides of the equation too). Most sleep labs have very limited bed availability, and when a staff member calls in sick they may have even less.

In reality, in lab sleep tests are available to very few when you consider the costs and resources. That leaves a huge population of untreated OSA patients. I'm not saying everyone can or should be diagnosed strictly with a reliable and validated home sleep test. Some people have more complex apneas or other sleep disordered breathing conditions which need further assessment in a sleep lab setting. Some would choose an in lab sleep test in the first place because they feel it will be more thorough or provide them with a better understanding of the condition. Patients should be able to choose an in lab test if they feel that way (no choice with insurers like Kaiser). But I would guess that Kaiser does a better job of diagnosing and treating OSA than most insurers because they use the home sleep test (I have other beefs with Kaiser, but I think they do this well). It's in their best interests not to miss identifying people with OSA, because (especially now that their ACA plans don't cover the costs and they can perpetually bill Advantage patients!) it's far cheaper to identify and treat OSA than the downstream effects of untreated OSA.

I gladly give you the last word.

You've earned it.