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Examiner
  • Sleep studies: Coming soon to a home near you

  • If you suspect you may have a sleep or wakefulness disorder and have put off getting a sleep study because you’re uncomfortable with the idea of spending a night in a medical facility, hooked up to monitoring equipment, I have news.

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  • If you suspect you may have a sleep or wakefulness disorder and have put off getting a sleep study because you’re uncomfortable with the idea of spending a night in a medical facility, hooked up to monitoring equipment, I have news.
    Home sleep testing is here and is gaining in popularity, partly because it’s often easier for the patient and less expensive-emphasis on less expensive. Home sleep testing has also grown in popularity because a growing number of health insurance companies are now requiring the home testing, prior to a clinic procedure, in an effort to curb costs.
    In 2011, an estimated $5.4 billion was spent on testing (both in labs and at home) for obstructive sleep apnea. Last March, the Centers for Medicare and Medicaid Services, whose reimbursement rules typically get adopted by private health insurers, dropped its opposition to home studies.
    According to a National Coverage Determination, home studies using a device that measures airflow, heart rate and oxygen saturation could be used (and covered) for diagnosing obstructive sleep apnea. Still, the home test must be ordered and supervised by a treating physician.
    In response to the new reality, St. Mary’s Medical Center’s Sleep Clinic is now offering home testing. Early testing has given us good data, but it won’t completely replace the need for full sleep lab testing.
    Home monitoring does have its limitations. First, it is only for patients with breathing issues. Unlike traditional in-laboratory sleep studies, the home tests do not screen for more than 80 other potential sleep disorders.
    Also, be aware that home sleep testing does not objectively monitor sleep or wakefulness as in a laboratory setting, because only limited sampling of blood oxygenation, heart rate or respiratory airflow are recorded.
    As a result, an in-home sleep study may underestimate the true severity of obstructive breathing in your sleep. This is particularly true if you sleep only partially during the night, since breathing rarely stops while awake. Also, more subtle breathing disruptions that may interrupt sleep, like snoring, are not recorded as accurately as they would be during polysomnography (in-laboratory sleep studies).
    That said, I feel the home testing device will provide a valuable screening tool for many patients, either those who don’t believe they have a sleep issue like apnea, or those whose insurance will not cover full sleep studies in a clinic setting.
    The test kit involves a recording unit and just six wired connections to the body. In a full sleep lab study, about 25 sensors are placed on the body. I walk patients through the process of setting up the device, in an effort to minimize errors. The unit is returned to our lab for analysis and recommendations, which may include treatment by positive airway pressure through a CPAP device.
    Page 2 of 2 - Again, since portable monitoring devices don’t detect all cases of sleep apnea, your doctor may still recommend polysomnography even if your initial results are normal.
    For some with obstructive sleep apnea, your doctor may refer you to an ear, nose and throat doctor to rule out any blockage in your nose or throat. Evaluations by a cardiologist or neurologist may also be necessary to check for other causes of central sleep apnea.
    An estimated 50 to 70 million American adults have a sleep or wakefulness disorder. People who experience sleep insufficiency are also more likely to suffer from chronic diseases such as hypertension, diabetes, depression and obesity, as well as from cancer, increased mortality and reduced quality of life and productivity
    Your partner’s snoring could be a sign that it’s time for a sleep study.
    Andy Portwood is Sleep Lab Technical Supervisor sleep clinician with St. Mary’s Medical Center Sleep Clinic. He can be reached at 816-655-5394.
     
     

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