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ADVANCE Perspective: Respiratory Views

Live From NAMDRC: Home Sleep Apnea Testing Controversy

Published March 18, 2010 6:27 PM by Mike Bederka
SAN DIEGO--NAMDRC's 33rd Annual Meeting and Educational Conference kicked off with a "controversial" and "contentious" topic.

"People are worried," said Charles Atwood, MD, FCCP, FAASM, professor of medicine, University of Pittsburgh Medical Center, during Home Sleep Apnea Testing: State of the Art. "They feel anxiety on where the future is heading."

Some sleep lab owners and physicians who read a lot of PSGs see home sleep apnea testing (HSAT) as a threat, he said, and many are satisfied with the status quo.

On the other side, supporters of HSAT include CMS, CPAP manufacturers, capitated health plans, other insurers, home care, patients and patient advocacy groups, and some physicians. Dr. Atwood fits into this later camp.

"I'm not opposed to (HSAT)," he told approximately 125 attendees. "It's inevitable. Let's be part of the change rather than be run over by it."

CMS currently approves HSAT for prescribing of CPAP. Devices must be level 2, 3, or 4 with three channels or the WatchPat, Dr. Atwood said. However, questions and issues still remain:
  • there's no real standardization of technology
  • which signals have the most value
  • low reimbursement.

Dr. Atwood concluded his talk by discussing his work on the Veterans Sleep Apnea Treatment Trial and practical applications of HSAT. His study found for patients attending a VA sleep clinic for sleep apnea, "home-based diagnostic testing and subsequent treatment with auto-CPAP at home is non-inferior to the traditional lab-based approach."

He also urged physicians to consider adding HSAT to their sleep lab, pick one HSAT system and "know it well," and stick to straightforward OSA patients. "Those who cannot adapt, then you become like the dinosaurs," he summed up.


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