The potential I see here is significant.
It is not hard to buy disposable SpO2/pulse probes for all types of PO.
They must be down to a few dollars each now.
The electronics in a modern finger PO are almost down to a 2-chip set & run by 1 or 2 small batteries.
It will not be long nor that difficult to add PO capability to this strip and to get enough detail to resolve much of the criticism of the strip alone.
I remain impressed at their goals. I also agree re the current concerns.
DSM
At Home Obstructive Sleep Apnea Screener Now Available
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Guest
doh give it up guest! you are making us look bad, your lies are showing up in your writing.Anonymous wrote:Huh. Wierd. The DME company I went through suggested I try one of these first. So there's one down. Oh, and they also don't charge $1,700.00 for a cpap. Nor does the company I'm using now after I moved. Huh. Wierd. Oh wait, maybe you were exaggerating!Anonymous wrote:I don't need to go to sleepapnea.org and read what it says there, I would not expect any RRT or RPSGT to say one word positive about this screening process afterall, they are trying to protect their livelyhood, their jobs.
I also wouldn't expect the brick and mortar DME's to highly endorse it either. People who will use it don't have insurance, don't have the money for a $3,000 PSG only to be told you need to come back again for another $3,000 titration then be sent to a DME that is going to rip them off close to $1700 for a $620 machine.
patients that would take advantage of the sleep strip would not be using their services anyway.
$150 bucks to screen you for OSA? I say go for it, what have you got to lose other than your health. Spend another $750 on a autotitrating machine and mask setup and your still under $1,000.
In the end there is no difference other than money spent.
However when even the manufacturer of the item says it's not a substitute for a full sleep study then maybe the statement that "there is no difference other than money spent" is a bit of an exaggeration too.
why would you go to a DME and them then suggest the screening sleep strip? are you not that bright?
most would go there AFTER any screening, after any diagnosis has been completed by a doctor for getting a machine not to have another screening procedure done, an obvious lie on your part. you must work for some big sleep center with that kind of intelligence.
in the end there is the script and the machine and the money you spent to get there.
on second thoughts... why reinvent the wheel?
I would prefer seeing cpap.com stocking a $150-$200 recording Pulse Oximeter that I could purchase, plug into my laptop, dump the data. Then I could take advantage of it and use it if not every night once a week, once a month etc. to ensure my treatment is still doing the job it is supposed to.
The Pulse Oximeter would be probably more accurate and easier to interpret than the sleep strip, would appeal to a wider audience and generate more sales for cpap.com.
It doesn't have to be all that accurate, you can buy the Nonan sport versions for mountain climbing, flying etc. at REi and other sporting goods, but they don't record so you can't find out what happened last night.
It doesn't have to have a printer, just needs to dump the data in a text file where you can read it, email it etc. If I seen where my oxygen levels were dropping and I couldn't address it, I'd be emailing that data to my doc.
Pulse Oximeter does make more sense.
I would prefer seeing cpap.com stocking a $150-$200 recording Pulse Oximeter that I could purchase, plug into my laptop, dump the data. Then I could take advantage of it and use it if not every night once a week, once a month etc. to ensure my treatment is still doing the job it is supposed to.
The Pulse Oximeter would be probably more accurate and easier to interpret than the sleep strip, would appeal to a wider audience and generate more sales for cpap.com.
It doesn't have to be all that accurate, you can buy the Nonan sport versions for mountain climbing, flying etc. at REi and other sporting goods, but they don't record so you can't find out what happened last night.
It doesn't have to have a printer, just needs to dump the data in a text file where you can read it, email it etc. If I seen where my oxygen levels were dropping and I couldn't address it, I'd be emailing that data to my doc.
Pulse Oximeter does make more sense.
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Guest
Look. You know nothing about me so please lay off the personal attacks. Did you ever stop to consider that I maybe already had a relationship with a DME provider due to getting a nebulizer and monthly medications? Did you ever stop to consider that they were just trying to help me out since I had to wait to get into the sleep lab? No you didn't. You just went and automatically assumed that I was for some reason trying to come here and lie about my experiences. You just automatically assumed that because someone had something nice to say about a DME company that they are lying about it.Anonymous wrote:doh give it up guest! you are making us look bad, your lies are showing up in your writing.
why would you go to a DME and them then suggest the screening sleep strip? are you not that bright?
most would go there AFTER any screening, after any diagnosis has been completed by a doctor for getting a machine not to have another screening procedure done, an obvious lie on your part. you must work for some big sleep center with that kind of intelligence.
in the end there is the script and the machine and the money you spent to get there.
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Guest
I agree this is a godsend for people like me who can't afford the sleep study. I understand why the professionals who posted here point out its shortcomings. But its better than nothing, which is my only affordable alternative.Anonymous wrote:$150 bucks to screen you for OSA? I say go for it, what have you got to lose other than your health. Spend another $750 on a autotitrating machine and mask setup and your still under $1,000.
What is the name and location of your DME?Anonymous wrote:The DME company I went through suggested I try one of these first.
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NightHawkeye
- Posts: 2431
- Joined: Thu Dec 29, 2005 11:55 am
- Location: Iowa - The Hawkeye State
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Guest
That is a good idea snoredog. I wonder if you can get an oximeter like you described as cheaply as the $150.00 sleep strip. If you could, it sounds like that would be a better way to go.Snoredog wrote:I would prefer seeing cpap.com stocking a $150-$200 recording Pulse Oximeter that I could purchase, plug into my laptop, dump the data. Then I could take advantage of it and use it if not every night once a week, once a month etc. to ensure my treatment is still doing the job it is supposed to.
The Pulse Oximeter would be probably more accurate and easier to interpret than the sleep strip, would appeal to a wider audience and generate more sales for cpap.com.
It doesn't have to be all that accurate, you can buy the Nonan sport versions for mountain climbing, flying etc. at REi and other sporting goods, but they don't record so you can't find out what happened last night.
It doesn't have to have a printer, just needs to dump the data in a text file where you can read it, email it etc. If I seen where my oxygen levels were dropping and I couldn't address it, I'd be emailing that data to my doc.
Pulse Oximeter does make more sense.
My understanding about pulse oximetery as a sleep apnea screening method is that a pulse ox is said by some doctors to be "good for ruling apnea in, but mediocre at best toward ruling apnea out". That is because a fair percentage of sleep apnea patients supposedly experience SDB-related sleep arousals without significant SpO2 desaturations. That implies many of these patients can and supposedly do suffer a severely deteriorated sleep architecture. A severely deteriorated sleep architecture, in and of itself, is thought to entail both comorbidities and very serious quality-of-life issues.
When a doctor says that a pulse oximeter is good for ruling apnea in, but not-so-good for ruling apnea out, to me that implies that pulse oximetry likely entails a mediocre sensitivity, but an adequate specificity as an apnea screening tool. How, then, does that differ from the test strip as a screening method? When I see a zero score indicating an AHI between 1 and 14, I kind of wonder why the sleep strip could not achieve an industry-wide accepted AHI measurement tier of 0 through 5. My guess is that the technology couldn't achieve it.
What does that say about the resulting sensitivity and specificity relative to that screening method, and relative to sleep industry standards that embrace an AHI tier of 0 through 5? It probably says that the test strip will return a much better sensitivity/specifiity score against it's own non-industry-standard tier ranking of apnea positive than it would compared to industry standards. Still, what does that test strip say, overall, about sensitivity/specificity scores relative to true apnea-positive cases that exist in the real world? My guess is that as an overall screening method it will return better specificity than sensitivity relative to real world apnea positive cases. My guess is because I personally expect that high-AHI apnea candidates will return apnea-positive scores (and not necessarily in the correct scoring tier) compared to low-AHI apnea candidates. Peg out the scale with this test strip and you probably have a genuine apnea case. Score that bottom tier of zero, and who really knows whether you have an apnea case on your hands?
So what do you do in this latter case? Test them further I would hope. But that would imply that everyone should go on to the next stage of apnea screening, diagnostics, or testing does it not? So what's the purpose of the test strip then? In my mind the argument for pulse oximetry (with its adequate apnea-screening specificity, yet low sensitivity) as a standalone apnea screening device might be pretty similar. Someone screens apnea-positive on the recording pulse ox. Send them on to the next stage of testing because you're pretty sure they have apnea. Oooops! Here's a person who snores terribly, but tested apnea-negative on the pulse oximeter. What do we do? We send them on to the next stage of testing as well. If we have no confidence in low or mediocre-sensitivity screening technology, then shouldn't we send all candidates on to the next stage of testing? So what was the screening purpose of the pulse oximeter or even the test strip? What is the purpose of screening technology in general?
Perhaps this is where the art of medicine enters the picture. Perhaps we allow the doctor to evaluate all screening tools (including questions) combinationally before deciding which lucky apnea candidates don't have to proceed to the next stage of testing. They sure won't be very lucky if the doctor screened them wrong. Perhaps we simply require that all apnea candidates bypass screening technology (technology that is inherently less comprehensive than diagnostic technology) and take a PSG? But wait... many people here, myself included, contend that PSG tests are not always possible for an entire variety of reasons.
Therein lies a genuine dilemma of modern sleep medicine if you ask me. I honestly don't know what the correct answer is. I'll admit that in the big picture of things I'm not convinced yet that the screening strip is a good or bad thing. I will say that as always I am very glad to hear all of your arguments.
When a doctor says that a pulse oximeter is good for ruling apnea in, but not-so-good for ruling apnea out, to me that implies that pulse oximetry likely entails a mediocre sensitivity, but an adequate specificity as an apnea screening tool. How, then, does that differ from the test strip as a screening method? When I see a zero score indicating an AHI between 1 and 14, I kind of wonder why the sleep strip could not achieve an industry-wide accepted AHI measurement tier of 0 through 5. My guess is that the technology couldn't achieve it.
What does that say about the resulting sensitivity and specificity relative to that screening method, and relative to sleep industry standards that embrace an AHI tier of 0 through 5? It probably says that the test strip will return a much better sensitivity/specifiity score against it's own non-industry-standard tier ranking of apnea positive than it would compared to industry standards. Still, what does that test strip say, overall, about sensitivity/specificity scores relative to true apnea-positive cases that exist in the real world? My guess is that as an overall screening method it will return better specificity than sensitivity relative to real world apnea positive cases. My guess is because I personally expect that high-AHI apnea candidates will return apnea-positive scores (and not necessarily in the correct scoring tier) compared to low-AHI apnea candidates. Peg out the scale with this test strip and you probably have a genuine apnea case. Score that bottom tier of zero, and who really knows whether you have an apnea case on your hands?
So what do you do in this latter case? Test them further I would hope. But that would imply that everyone should go on to the next stage of apnea screening, diagnostics, or testing does it not? So what's the purpose of the test strip then? In my mind the argument for pulse oximetry (with its adequate apnea-screening specificity, yet low sensitivity) as a standalone apnea screening device might be pretty similar. Someone screens apnea-positive on the recording pulse ox. Send them on to the next stage of testing because you're pretty sure they have apnea. Oooops! Here's a person who snores terribly, but tested apnea-negative on the pulse oximeter. What do we do? We send them on to the next stage of testing as well. If we have no confidence in low or mediocre-sensitivity screening technology, then shouldn't we send all candidates on to the next stage of testing? So what was the screening purpose of the pulse oximeter or even the test strip? What is the purpose of screening technology in general?
Perhaps this is where the art of medicine enters the picture. Perhaps we allow the doctor to evaluate all screening tools (including questions) combinationally before deciding which lucky apnea candidates don't have to proceed to the next stage of testing. They sure won't be very lucky if the doctor screened them wrong. Perhaps we simply require that all apnea candidates bypass screening technology (technology that is inherently less comprehensive than diagnostic technology) and take a PSG? But wait... many people here, myself included, contend that PSG tests are not always possible for an entire variety of reasons.
Therein lies a genuine dilemma of modern sleep medicine if you ask me. I honestly don't know what the correct answer is. I'll admit that in the big picture of things I'm not convinced yet that the screening strip is a good or bad thing. I will say that as always I am very glad to hear all of your arguments.
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Guest
You said a mouthful, SWS. I didn't stop to consider those who don't experience significant desats but still have SDB. The oximeter wouldn't tell them anything- or worse, might lead them to believe they don't have a problem when they actually might. It puts the oximeter in the same category as the sleep strip in terms of accurate screening. Some will be missed.
The expensive PSG is the gold standard, but even if you assume it is done correctly by a top-notch technician (a big and all-too-often erroneous assumption) it is difficult to capture a typical night's sleep and all the data that entails... so it has it's shortcomings as well.
If money were no object, I'd have a PSG. Heck, I'd have several of them in the span of a couple months at different centers throughout the country to increase my odds of being appropriately setup and scored, and to get accurate data and a true picture of my sleep architecture.
If money mattered, I'd probably try the sleep strip and the oximeter.
If I wasn't convinced of the outcome of any of these methods, I'd probably get myself an APAP and the software and start experimenting. (Of course, we know that wouldn't tell me everything either!)
This all points to the fact sleep science is still in its infancy. There are lot of deficiencies, imperfections and inconsistencies and I'm not convinced the technology will ever exits to uncover all the underlying etiologies involved in SDB, or the accurate diagnosis of them.
Who'd have ever thought simply breathing in and out while sleeping was such complicated business! My feeling, at this point, is any tool we can use to evaluate our needs is better than nothing. I'm of the opinion one should buy the best tool one can afford and keep in mind it won't necessarily tell the whole story!
The expensive PSG is the gold standard, but even if you assume it is done correctly by a top-notch technician (a big and all-too-often erroneous assumption) it is difficult to capture a typical night's sleep and all the data that entails... so it has it's shortcomings as well.
If money were no object, I'd have a PSG. Heck, I'd have several of them in the span of a couple months at different centers throughout the country to increase my odds of being appropriately setup and scored, and to get accurate data and a true picture of my sleep architecture.
If money mattered, I'd probably try the sleep strip and the oximeter.
If I wasn't convinced of the outcome of any of these methods, I'd probably get myself an APAP and the software and start experimenting. (Of course, we know that wouldn't tell me everything either!)
This all points to the fact sleep science is still in its infancy. There are lot of deficiencies, imperfections and inconsistencies and I'm not convinced the technology will ever exits to uncover all the underlying etiologies involved in SDB, or the accurate diagnosis of them.
Who'd have ever thought simply breathing in and out while sleeping was such complicated business! My feeling, at this point, is any tool we can use to evaluate our needs is better than nothing. I'm of the opinion one should buy the best tool one can afford and keep in mind it won't necessarily tell the whole story!
Interesting update, or so it would seem. Respironics has a new entry into the apnea home screening market. They refer to this product on their own web site as the "RUSleepingTM RTS Screener for Apneic Events". Here is that web site: http://rusleeping.respironics.com/
(PICTURED ABOVE IS A NEW ENTRY INTO THE APNEA HOME SCREENING MARKET BY RESPIRONICS)
Below is a product link and picture to the home-screening device that spawned this thread-based announcement and its subsequent discussion: https://www.cpap.com/productpage/slp-sl ... study.html
(THE PICTURE BELOW IS THE HOME SCREENING DEVICE THAT WAS ORIGINALLY ANNOUNCED AND DISCUSSED IN THIS THREAD)
My own revisited and additional thoughts (for which I do not yet have answers): How do these two flow-based screening devices differ? How are they similar? How might the screening results yielded by any nasal flow-based screening device compare to the screening results yielded by a recording pulse oximeter? Do these two categories of home screening technology compete with each other--- i.e. are they largely redundant? Or might these two screening technologies be used in tandem to yield even better screening results? What general role does screening play in diagnoses, and what are screening's significant caveats in fulfilling that role? My answer to all of the above: dunno.
Also, I'm admittedly wondering if anyone has changed opinions regarding the validity of home-based screening in general. Any additional thoughts or discussions about home screening are certainly welcome into this or any other thread (unfortunately I won't have time to participate in any threads for a couple/few weeks). I just thought others might find this update to the home screening topic as interesting as I did!
(PICTURED ABOVE IS A NEW ENTRY INTO THE APNEA HOME SCREENING MARKET BY RESPIRONICS)
Below is a product link and picture to the home-screening device that spawned this thread-based announcement and its subsequent discussion: https://www.cpap.com/productpage/slp-sl ... study.html
(THE PICTURE BELOW IS THE HOME SCREENING DEVICE THAT WAS ORIGINALLY ANNOUNCED AND DISCUSSED IN THIS THREAD)
My own revisited and additional thoughts (for which I do not yet have answers): How do these two flow-based screening devices differ? How are they similar? How might the screening results yielded by any nasal flow-based screening device compare to the screening results yielded by a recording pulse oximeter? Do these two categories of home screening technology compete with each other--- i.e. are they largely redundant? Or might these two screening technologies be used in tandem to yield even better screening results? What general role does screening play in diagnoses, and what are screening's significant caveats in fulfilling that role? My answer to all of the above: dunno.
Also, I'm admittedly wondering if anyone has changed opinions regarding the validity of home-based screening in general. Any additional thoughts or discussions about home screening are certainly welcome into this or any other thread (unfortunately I won't have time to participate in any threads for a couple/few weeks). I just thought others might find this update to the home screening topic as interesting as I did!
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rested gal
- Posts: 12881
- Joined: Thu Sep 09, 2004 10:14 pm
- Location: Tennessee
Interesting... I went to the RUsleeping link. Looked all through the instructions for using the product. Wondered what it would say about mouth breathing. Only thing I found about the "mouth" was this, in all caps on the trouble-shooting page:
DO NOT PLACE TAPE OVER THE MOUTH OR NOSTRILS
Wonder if mouth breathing (either constant or intermittent) during sleep is accounted for with that kind of nasal cannula screening tool?
DO NOT PLACE TAPE OVER THE MOUTH OR NOSTRILS
Wonder if mouth breathing (either constant or intermittent) during sleep is accounted for with that kind of nasal cannula screening tool?
ResMed S9 VPAP Auto (ASV)
Humidifier: Integrated + Climate Control hose
Mask: Aeiomed Headrest (deconstructed, with homemade straps
3M painters tape over mouth
ALL LINKS by rested gal:
viewtopic.php?t=17435
Humidifier: Integrated + Climate Control hose
Mask: Aeiomed Headrest (deconstructed, with homemade straps
3M painters tape over mouth
ALL LINKS by rested gal:
viewtopic.php?t=17435
Interesting devices both of them !. I come back to the point that any such devices are a good start even if the early versions don't do everything the way we want it.
My ideal home screening device would ...
1) be able to score a reasonably accurate AI number
2) would be able to score HI as a seperate value
3) would have a solution for those who mouth breathe (i.e. seal mouth if that is practical)
3) would be reuseable
Just like the evolution of cpap itself - I expect home screening devices may start off as humble compared to a PSG but one day be able to come pretty close.
DSM
My ideal home screening device would ...
1) be able to score a reasonably accurate AI number
2) would be able to score HI as a seperate value
3) would have a solution for those who mouth breathe (i.e. seal mouth if that is practical)
3) would be reuseable
Just like the evolution of cpap itself - I expect home screening devices may start off as humble compared to a PSG but one day be able to come pretty close.
DSM
xPAP and Quattro std mask (plus a pad-a-cheek anti-leak strap)
Exactly. I only desaturated to 84% in my sleep study. Many don't go below 90% yet have severe OSA.-SWS wrote:My understanding about pulse oximetery as a sleep apnea screening method is that a pulse ox is said by some doctors to be "good for ruling apnea in, but mediocre at best toward ruling apnea out".
I appreciate their goals, but capitalism is getting in the way of them declaring the actual benefits of the device. It seems to be like a pulse ox, in that it can rule OSA in, but not do a very good job of ruling it out. Fine. Take it for what it is, and remember how much it costs, and move on with your life.
What a coincidence... My bags are already packed to move on.blarg wrote: Take it for what it is, and remember how much it costs, and move on with your life.
But when I get back from the Caribbean... with both an R&D engineering background and an apnea diagnosis already under my belt... and still having a "years-old" interest in the topics of technology and sleep... and still enjoying helping others understand both topics via the message boards... THEN what should I do?
Repack my bags...
I just meant the people that feel the need to lambast the device because it might convince some people they don't have apnea when they do. I hope people use them as a screening tool and if they still have trouble sleeping when they got a 0 score on one of the sleep strips, then it's time for a sleep study. PLMD, etc happen.-SWS wrote:and still having a "years-old" interest in the topics of technology and sleep... and still enjoying helping others understand both topics via the message boards... THEN what should I do?
You can be content to live wherever you want.