Home OSA Testing and Auto Titration vs. Lab

"Obstructive sleep apnea patients adhere to positive airway pressure treatment
just as well whether diagnosis and titration occur at home or in the sleep
laboratory, researchers found.

Every measure of adherence showed statistically similar outcomes between portable home
testing with auto-titration, and polysomnography with office-based titration,
Lt. Col. Christine Lettieri, MD, of Dewitt Army Community Hospital in Fort
Belvoir, Va., and colleagues reported here at the CHEST meeting."

Full article: http://www.medpagetoday.com/MeetingCoverage/CHEST/23156

Primary Care and home studies do it as well as the sleep labs at a much lower cost!!! (and with less bullshit).

Watch the cute lieutenant colonel in the video. She says some very important things about how PCPs doing these studies will get the PCP more aware and therefore get many more people diagnosed and treated properly.

That's got to be the way of the future. I got my billing statements from my insurance company and was surprised at the cost of the sleep study. Around $2200 each night. In uncomplicated cases it seems a home study should be able to accomplish that. Sure, you're not going to have real-time EEG and EKG data available, but is that really necessary? Couldn't the home study be used as an initial diagnostic screening procedure, and if the data indicates all is not right, only THEN authorize an in-lab study?

[And yes, she IS a looker!]

Interesting study--kudos again to you Rooster:
I noted that the home study was not used on severe OSA cases; which indicates that the initial diagnostic study was probably done in-lab.
It is interesting that they assumed sufficient patient training is being done by sleep labs or DME's (how do they KNOW?)
I believe that CPAP training like current diabetes training, will have to be formalized in order to be both uniform and adequate.
This forum is wonderful; but it is not everybody's cup of tea.
We need EDUCATION available to every OSA patient BEFORE they even shop for a machine--yes, SHOP-dagnabbit!
And Medicare and the insurance companies need to get out of bed with the providers.
Costs can be reduced with improved care. Isn't that exactly what they say they want?
OK, I've ranted; thank you for your patience.

chunkyfrog wrote: We need EDUCATION available to every OSA patient BEFORE they even shop for a machine--yes, SHOP-dagnabbit!
And Medicare and the insurance companies need to get out of bed with the providers.

..yea....but they need real education, like they get here,
not the aforementioned bullshit that you get from the
sleep lab and DME.

I don't see that happening anytime soon.

chunkyfrog wrote: Costs can be reduced with improved care. Isn't that exactly what they say they want?

I don't think any of them are truly interested in reduced costs.

How can you tell when the sleep lab/DME are lying to you?
Their lips are moving.

Yep. Get the sorry sleep labs and sorrier B&M DMEs out of the education (dis-education) process.

Of course my internet DME, cpap.com, is in the education process in a fine way (cpaptalk.com).

My insurance pays for diabetes education every 2 years.
I found two--count them: 2-- books on sleep disorders in the Barnes&Nobel bookstore.
One had 4 pages on Xpap. The other looked like a total snooze.
Why no Idiot/Dummy guides?
Maybe--Amazon?

Kaiser, to my knowledge, does ONLY home OSA testing.

If you are referred for a sleep study, you have to attend a class where they give you an overview of sleep apnea and then tell you exactly how to put on and use the testing machine, and how to remove it in the morning so you don't damage the sensors. Kaiser uses an older version of the Watch Pat by Itamar, and it's incredibly simple. You place sensors on two fingers and strap the thing to your arm and go to sleep.

Personally it seems to me that this type of testing has GREATER validity because it's done in your own bed, in your normal sleeping conditions, in your normal sleeping position. I hear so many stories about how difficult or impossible it is to sleep in a sleep lab setting and how many people never go into REM sleep at all because they are so uncomfortable in the strange environment hooked up to a zillion sensors and watched every moment.

I think if you have a case of straightforward OSA it makes total sense to do testing this way. I'm not sure how Kaiser deals with complicating factors like complex apnea, RLS, UARS, and PLMD though. There should be some option for in lab testing when those are indicated (and perhaps Kaiser does, but I'm not aware of it).

Kaiser is all about doing things economically, but that doesn't have to mean that their approach is not valid. To me it makes much more sense and I think if more sleep centers did this, there would be better diagnosis for less cost and more people who need it getting treatment.

chunkyfrog wrote:My insurance pays for diabetes education every 2 years.
I found two--count them: 2-- books on sleep disorders in the Barnes&Nobel bookstore.
One had 4 pages on Xpap. The other looked like a total snooze.
Why no Idiot/Dummy guides?
Maybe--Amazon?

A friend told me the day he was diagnosed with type 2 diabetes he drove to Books-A-Million on the way home and picked out five books out of many and went home and read through all five before he read another thing. I agree with you - it should be that way with sleep apnea and CPAP. In the long run the need for books on diabetes would be reduced.

Janknitz wrote: Personally it seems to me that this type of testing has GREATER validity because it's done in your own bed, in your normal sleeping conditions, in your normal sleeping position. I hear so many stories about how difficult or impossible it is to sleep in a sleep lab setting and how many people never go into REM sleep at all because they are so uncomfortable in the strange environment hooked up to a zillion sensors and watched every moment.

Ditto Jan!