Incorporating Home Sleep Studies into the Diagnostic and Treatment Armamentarium

Because Type 3 studies can be slightly less sensitive on average than lab PSG, a negative result in a symptomatic patient should be repeated in the lab.

Who Are the Best Candidates?

Peter D. O’Connor, MD, OD, of the Department of Otolaryngology-Head and Neck Surgery, Sleep Medicine and Surgery at Brooke Army Medical Center in San Antonio, TX, spent some time in his presentation advising participants on careful patient selection. As the AASM notes in its Clinical Guidelines decision tree, the most appropriate use of HSS is in patients who have a high pretest probability of moderate to severe OSA. If patients have signs or symptoms of co-morbid disorders, it’s best to order lab PSG.

Dr. O’Connor noted that as of September 2009, 87 different HSS devices-primarily Type 3 and 4-were listed on the FDA Web site. It’s important to understand what the test provides, to whom you can apply it, whether the device has been validated, whether it has limitations, and whether you can utilize it within the parameters set by CMS, he said.

Dr. Brietzke wrapped up the session, noting other advantages of incorporating OSA diagnosis into one’s practice. He and his colleagues at Walter Reed Army Medical Center are very focused on sleep apnea, screening for and treating it often. Using simple tools, such as the sleep history or sleep diary,6 can help identify common problems and other comorbid conditions. For instance, using the simple mnemonic URGE (Urge to move; Rest makes it worse; Gets better with movement; Evening only) can help physicians identify and treat the high prevalence of restless legs syndrome. Dr. Brietzke reiterated the advice of his fellow panelists, all of whom are board-certified in sleep medicine, to consider certification by the American Board of Otolaryngology which is a member of the American Board of Medical Specialties’ conjoint board of Sleep Medicine. Otolaryngologists willing to take up the challenge of board certification can then ensure that they can optimize the new CMS ruling, retaining and following their patients over time. This increased continuity of care, they said, is good for the doctor and good for the patient.

References

1. Institute of Medicine. Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem, March 2006. Available from the IOM Web site at http://www.iom.edu/Reports/2006/Sleep-Disorders-and-Sleep-Deprivation-An-Unmet-Public-Health-Problem.aspx .

   [Context Link]

2. Senn O, Brack T, Russi EW, Bloch KE. A continuous positive airway pressure trial as a novel approach to the diagnosis of the obstructive sleep apnea syndrome. Chest 2006;129:67-75.

   [Context Link]

3. Collop NA, Anderson WM, Boehlecke B, Claman D, et al. Clinical guidelines for the use of unattended portable monitors in the diagnosis of obstructive sleep apnea in adult patients. J Clin Sleep Med 2007;3:737-47.

   [Context Link]

4. Iber C, Redline S, Kaplan Gilpin AM, Quan SF, et al. Polysomnography performed in the unattended home versus the attended laboratory setting-Sleep Heart Health Study methodology. Sleep 2004;27:536.

   [Context Link]

5. Collop NA. Scoring variability between polysomnography technologists in different sleep laboratories. Sleep Med 2002;3:43-47.

   [Context Link]

6. Davidson TM. Sleep medicine for surgeons. Laryngoscope 2008;118:915-31.

   [Context Link]

©2009 The Triological Society