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

This medical center (very close to N.Y. City) will be screening [all?] patients with cardiovascular disease for Sleep Apnea.

My suspicion is that the percentage that have it will be an eye opener, and will lead to much more testing.

Link ===> https://www.tapinto.net/towns/hackensac ... ea-at-home

Kaiser has been doing that more than a decade.

Janknitz wrote: ↑

Mon Aug 26, 2019 1:51 pm

Kaiser has been doing that more than a decade.

Thanks. Can you please provide a link. I wasn't able to find this.

D.H. wrote: ↑

Mon Aug 26, 2019 4:01 pm

Janknitz wrote: ↑

Mon Aug 26, 2019 1:51 pm

Kaiser has been doing that more than a decade.

Thanks. Can you please provide a link. I wasn't able to find this.

Somewhere there is a study published by Kaiser Permanente on using home sleep studies and titrations, but I don't have the time to go searching. Meanwhile, do a search on "Kaiser" here and you will see that they almost universally do home sleep studies using the Watch Pat device. If you google "Kaiser sleep study" you will see their blurbs say that you may have an at home or in lab sleep study, but in reality they pretty much only do home sleep studies.

The only member here I know of who had a follow up in lab sleep study with Kaiser because it was more than basic OSA was Kaia's Gram.

Janknitz wrote: ↑

Tue Aug 27, 2019 2:20 pm

The only member here I know of who had a follow up in lab sleep study with Kaiser because it was more than basic OSA was Kaia's Gram.

Hi Jan, I logged in to the forum today because I just received my new Autoset 10 and am getting up to speed on the setup, hacking into the clinical menu, etc... and I saw this post.

Like most all Kaiser patients I had the usual home sleep study with the Watch PAT device back in 2012. I had the in-hospital overnight study later because of some issues/questions about my at-home titration. It wasn't a diagnostic sleep study, only a titration.

I don't know under what circumstances Kaiser would have a patient do their diagnostic sleep study in the lab/hospital. My 92 year old mother, who has COPD and diabetes, was sent home with a Watch PAT for a diagnostic sleep study. She was also sent home for her titration with an open-settings autoset with no humidifier. And no opportunity to try on different masks as far as I know. Not surprisingly she quit shortly after she started, though she hung in there longer than I expected her to.

The at-home sleep study/titration practices have some definite advantages but also some distinct disadvantages, especially for those folks who need a little extra support with the process.

I agree with Kiasgram, it can be both advantageous and a disadvantage to do home testing and titration.

When I was going through the process at kaiser (always in a group setting) there were truckers having home sleep tests--they had to add a chest strap for additional readings to the Watch Pat and one person who had undergone a heart transplant but still had a home test. I think it's very rare that Kaiser is ever going to do an in lab test--perhaps for someone with very complex apnea and only after a home test fails to provide sufficient information.

The staff at my local Kaiser has been really good about letting me try on multiple masks (and they give me each one I try because they cannot clean and reuse them!) and other support needed, but I'm an educated "patient" and know how to ask for help. That wouldn't work for a 92 year old, but then again, a single night for titration in most sleep labs might not have done any better except that there was someone hands on to help with mask fitting (which can be hit or miss depending on the expertise and concern of the tech on duty).

Beware any program that involves flying with an "innovative pilot," especially a pilot that requires any "launching."

Any doc who does not care how a particular patient breathes while asleep is less than informed on the basics of human needs.

If a pretend study earns you a trial of the treatment, play along. But if the pretend study fails to do its job, insist on a real one.

Scientifically speaking, any test that cannot provide a definitive negative is a test that is incapable of "screening" anyone or anything.

Beware any program that involves flying with an "innovative pilot," especially a pilot that requires any "launching."

Any doc who does not care how a particular patient breathes while asleep is less than informed on the basics of human needs.

If a pretend study earns you a trial of the treatment, play along. But if the pretend study fails to do its job, insist on a real one.

Scientifically speaking, any test that cannot provide a definitive negative is a test that is incapable of "screening" anyone or anything.

There are already peer-reviewed published studies on the use of the Watch Pat device to diagnose OSA and Medicare already accepts this device for home testing, that's not the trial. There are studies already showing home sleep studies are effective to screen for OSA. This trial is really about whether that Medical Center can save money by using the Watch Pat device as their diagnostic standard for OSA in their A-Fib patients, and I'm quite sure it will.

Janknitz wrote: ↑

Fri Aug 30, 2019 6:28 pm

Beware any program that involves flying with an "innovative pilot," especially a pilot that requires any "launching."

Any doc who does not care how a particular patient breathes while asleep is less than informed on the basics of human needs.

If a pretend study earns you a trial of the treatment, play along. But if the pretend study fails to do its job, insist on a real one.

Scientifically speaking, any test that cannot provide a definitive negative is a test that is incapable of "screening" anyone or anything.

There are already peer-reviewed published studies on the use of the Watch Pat device to diagnose OSA and Medicare already accepts this device for home testing, that's not the trial. There are studies already showing home sleep studies are effective to screen for OSA. This trial is really about whether that Medical Center can save money by using the Watch Pat device as their diagnostic standard for OSA in their A-Fib patients, and I'm quite sure it will.

No home test can prove a subject's sleep cannot be improved by PAP.

Yes, a home test can indicate that a subject's sleep is likely to be improved by PAP.

Any home test that is used to allow people to try PAP is a good thing, in any context.

Any home test used to deny people PAP is a bad thing, in any context, since the AASM requires a negative result from a home test to be followed by a lab test, whether payors agree or not.

It really is that simple, if improved health is the only outcome factored in and economic expediency for payors is factored out.

I have actually had a number of overnight sleep studies through Kaiser -

My first study was a home study, and after the home titration, they did not give me a PAP, due to my apneas not being treated well enough with the home titration part,
and they sent me out for an overnight sleep lab study . . .

Since that first overnight study, I had a couple of overnight sleep studies scheduled with a daytime MLST study, and both had to be aborted because I wasn't able to sleep during the night study . . . Also, one overnight to check out a dental appliance, to see if that would work. And the most recent overnight study was to determine if the ResMed or the Respironics algorithm worked better for me - and Thank God it showed that I was better treated with the ResMed

So, all in all, since being diagnosed 7 years ago, I have had 5 overnight sleep studies with Kaiser

All that to say, likely the home study could be a good screening program, but the Overnight Sleep Study is so much more comprehensive, and is very beneficial for certain cases, like mine!

Home sleep tests are a beautiful way to get people on PAP in a hurry, since payors will accept that evidence for a PAP trial. But any doc or program that claims"your home test proved you don't need PAP" is engaged in professional medical gaslighting.

I walked away from reading the article with the understanding that the innovative part was that all cardiology patients would be tested, not just people presenting with insomnia or excessive sleepiness. The home testing would provide a cost effective way to diagnose and treat a group that had not previously been exposed to the possibility that sleep disordered breathing could be contributing to their health issues.

Once everyone in medicine finally gets it that it would be cost-effective to give everyone with any significant cardiovascular-related issues/risks (including, for example, diabetes, hypertension, and obesity) a PAP trial, I will then be willing to sign off on the word "innovative."

Hey, just me.

I am too jaded to celebrate or congratulate tiny incremental progress as corporations pat themselves on the back in their acknowledgment of the obvious. Once payors stop requiring ANY diagnostic testing for trialing PAP for the specific patients with a high probability of benefiting from PAP, THEN I will (grudgingly) nod in their direction in acknowledging that they may finally be getting a clue about the importance of sleep-breathing and realizing how cheap PAP is in comparison to the diagnostic hoops payors require docs to jump through to get patients to PAP. Why require the spending of hundreds of dollars of diagnosis (and substandard diagnosis at that) just for a patient to try a machine that only costs hundreds of dollars?

Response to therapy means much more than any non-lab testing, in the grand scheme of things.

But my views have never been standard and likely never will be.

jnk... wrote: ↑

Sat Aug 31, 2019 6:13 pm

Once everyone in medicine finally gets it that it would be cost-effective to give everyone with any significant cardiovascular-related issues/risks (including, for example, diabetes, hypertension, and obesity) a PAP trial, I will then be willing to sign off on the word "innovative."

Hey, just me.

I am too jaded to celebrate or congratulate tiny incremental progress as corporations pat themselves on the back in their acknowledgment of the obvious. Once payors stop requiring ANY diagnostic testing for trialing PAP for the specific patients with a high probability of benefiting from PAP, THEN I will (grudgingly) nod in their direction in acknowledging that they may finally be getting a clue about the importance of sleep-breathing and realizing how cheap PAP is in comparison to the diagnostic hoops payors require docs to jump through to get patients to PAP. Why require the spending of hundreds of dollars of diagnosis (and substandard diagnosis at that) just for a patient to try a machine that only costs hundreds of dollars?

Response to therapy means much more than any non-lab testing, in the grand scheme of things.

But my views have never been standard and likely never will be.

Gee. It sure seems like a $2 500+ in lab Sleep test makes great sense as compared to a $750 APAP machine
By my observation that is certainly the way Medicare is run. But they might also find a way to pay $2,500 for the APAP.

jnk... wrote: ↑

Fri Aug 30, 2019 10:20 pm

Janknitz wrote: ↑

Fri Aug 30, 2019 6:28 pm

Beware any program that involves flying with an "innovative pilot," especially a pilot that requires any "launching."

Any doc who does not care how a particular patient breathes while asleep is less than informed on the basics of human needs.

If a pretend study earns you a trial of the treatment, play along. But if the pretend study fails to do its job, insist on a real one.

Scientifically speaking, any test that cannot provide a definitive negative is a test that is incapable of "screening" anyone or anything.

There are already peer-reviewed published studies on the use of the Watch Pat device to diagnose OSA and Medicare already accepts this device for home testing, that's not the trial. There are studies already showing home sleep studies are effective to screen for OSA. This trial is really about whether that Medical Center can save money by using the Watch Pat device as their diagnostic standard for OSA in their A-Fib patients, and I'm quite sure it will.

No home test can prove a subject's sleep cannot be improved by PAP.

Yes, a home test can indicate that a subject's sleep is likely to be improved by PAP.

Any home test that is used to allow people to try PAP is a good thing, in any context.

Any home test used to deny people PAP is a bad thing, in any context, since the AASM requires a negative result from a home test to be followed by a lab test, whether payors agree or not.

It really is that simple, if improved health is the only outcome factored in and economic expediency for payors is factored out.

So, what's the rate of false negatives home test like the Watch Pat for identifying OSA, any idea?

Here's what their own website cites:
How accurate is WatchPAT in comparison to Polysomnography?
Numerous validations studies demonstrated a high degree of correlation in RDI (Respiratory Disturbance Index) and AHI (Apnea-Hypopnea Index) between same-setting WatchPAT and polysomnography (PSG) sleep studies with R= 0.85- 0.96. Moreover, the RDI and AHI scores are highly reproducible, showing correlation between at-home and in-laboratory sleep studies. Bar A, Pillar G, Dvir I, Sheffy J, Schnall RP, Lavie P. Evaluation of a portable device based on arterial peripheral tonometry (PAT) for unattended home sleep studies. Chest, March 2003, 123(3): 695-703. Pittman DS, Ayas NT, MacDonald MM, Malhotra A, Fogel RB, White D. Using a Wrist-Worn Device Based on Peripheral Arterial Tonometry to DiagnoseObstructive SleepApnea: In-Laboratory and Ambulatory Validation. Sleep 2004, Vol.27 (5), 923-933. Ayas N. TA, Pittman S, MacDonald M, White D. Assessment of a Wrist-Worn Device in the Detection of Obstructive Sleep Apnea. Sleep Medicine 2003, Vol. 4, (5), 435-442. Zou D, Grote L, Peker Y, Lindblad U, Hedner J. Validation a Portable Monitoring Device for Sleep Apnea Diagnosis in a Population Base Cohort Using Synchronized Home Polysomnography. Sleep 2006: 29(3): 367-374. S.D. Pittman, G. Pillar, RB Berry, A Malhotra, MM MacDonald, DP White. Follow-Up Assessment of CPAP Efficacy in Patients with Obstructive Sleep Apnea Using an Ambulatory Device Based on Peripheral Arterial Tonometry. Sleep and Breathing, 2006.