On Men: The Controversial Rise of Home-Based Sleep Testing
Men bear the brunt of obstructive sleep apnea. The sleep disorder, which is twice as common in men as in women, causes some 12 million Americans to temporarily and repeatedly stop breathing while they sleep. The condition may seem at first blush like a mere annoyance; it can cause heavy snoring and daytime drowsiness. But medical authorities warn that it can be lethal, as it's linked to increased risk of cardiovascular problems, stroke, and accidents.
Traditionally, doctors have diagnosed people with sleep apnea using polysomnography, a test that monitors variables such as brain activity, eye movement, and airflow. Typically, the test is performed during an overnight stay in a sleep clinic. The proliferation of cheaper, pared down, and more portable versions of polysomnography—called home or portable sleep tests—has made getting diagnosed with sleep apnea in the comfort of your own bed an option. Generally, however, the medical establishment has been dubious of these devices, which don't provide as much information as polysomnography performed in a lab.
But the case for home sleep tests seems to be gathering steam. The Centers for Medicare and Medicaid Services recently announced that it's planning to reimburse patients for the cost of their treatment if they're diagnosed with apnea using one of the home tests. Currently, reimbursement usually depends on a diagnosis from a lab. Some recent studies, including one that U.S. News reported on last February, have found that certain home-based tests can detect sleep apnea as effectively as laboratory tests. And there's little doubt that home testing will be cheaper and more convenient than lab testing, especially for people who are confined to their beds or who live in rural areas.
The CMS plan, however, has raised eyebrows in the sleep research community. Some sleep specialists say home testing isn't necessarily up to snuff. "Home testing is less comprehensive and more prone to misinterpretation by inexperienced operators," says Frank Ryan, a sleep specialist at the University of British Columbia who led the February 2007 study. Part of the reason for the effectiveness of home testing in that particular study, he says, was that it included only patients who'd been referred by a doctor to an apnea-diagnosing sleep clinic and so presumably were suspected of having sleep apnea. Generalizing the findings to other types of patients isn't yet appropriate, he says. "Before widespread acceptance, home testing should be subjected to broad validation and impact analysis."
All home-based tests are not equal. In fact, some are much more comprehensive than others. A "Type 2" sleep monitoring device, for example, monitors at least seven sleep parameters, while a "Type 4" device may monitor just one. ("Type 1" covers lab-based polysomnography, the most comprehensive test.) CMS has proposed that reimbursement for treatment costs, which is now limited to diagnoses made by polysomnography, extend to diagnoses made with Type 2, Type 3, and Type 4 products. The American Academy of Sleep Medicine, however, plans to challenge reimbursement for Type 4 devices, according to a memo published online by the academy's president.
In December, the AASM made a qualified endorsement of home sleep tests. According to the academy, tests should be used only for people with a high probability of having obstructive sleep apnea; they should not be used for people who have other sleep disorders such as central sleep apnea, insomnia, or narcolepsy; and they should not be used by children or older people who have medical conditions such as heart failure or stroke, which could interfere with the results.
It's worth noting that conducting polysomnography is a source of income for many sleep specialists who belong to the AASM. That said, if I suspected I had sleep apnea, I would follow the academy's cautious lead on home sleeping tests. The apnea treatment that this hubbub revolves around is known as CPAP, which involves a machine that mechanically assists patients' breathing. But there's more people can do to combat apnea. Getting to a healthy weight can make a big difference: Forty percent of obese patients have sleep apnea, and a full 70 percent of sleep apnea patients are obese.
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