Home sleep studies still under scrutiny

Monday, December 31, 2001

ROCHESTER, Minn. - Although Medicare has finally recognized the hypopnea as a symptom of obstructive sleep apnea, thus opening the door to more CPAP business, the prognosis for diagnosing or identifying sleep apnea in the home is still sketchy.

Currently, several leading physician-based associations, which more or less set the marching orders for clinical practices, are examining the viability of identifying sleep apnea in the home. The study, now conducted by the American Thoracic Society, the College of Chest Physicians, the American Academy of Sleep Medicine and two international organizations, has its roots in a workshop held in Chicago in Sept. 2000 (see HME News story, Nov. 2000).

That workshop was supposed to have produced a paper within six-12 months, but delays have pushed expectations for a new statement on sleep apnea to September of this year, according to Jerry Barrett, executive director of the American Academy of Sleep Medicine. The review paper, guidelines and executive summary will be published in the associations' journals.

Although respiratory therapists working in home care may argue that existing technology can do much of the work now being performed in sleep labs, and as a result reduce the long waits for studies at sleep labs, Barrett says the literature to support such claims is scant.

Moreover, some of the preliminary evidence now under examination by the associations' physicians does not support claims that being tested in the home is any cheaper than being tested in a lab, according to Barrett.

"What's going to be 'less' about it," said Barrett. "The lab is going to have to buy a vehicle. You'll have to transport the equipment, spend all sorts of tech time hooking that person up. You're still going to have expensive recorders out there."

Some estimates claim that a mere 5% of the 18 million people with OSA have been screened and tested for the condition. The staggering numbers of undiagnosed, and the development of a market to serve their condition, is part of the reason one leading respiratory therapist working in home care believes the bottleneck will continue to exist, and the opportunity for home medical sleep providers remain dim.

"CPAP is growing at 25% per year, and the only governor on the business right now is the lack of sleep beds," said the RT, who prefers not to be identified. "They don't want to open that door."

Nor, says the RT, does the American Academy of Sleep Medicine want to open the door. "Their constituents are sleep doctors who don't want to lose control of this business, which is exactly what would happen," said the RT. "To me, it's more of a political question than a clinical question."

Even Barrett acknowledges that financial questions about the sleep business rise to the surface when people start talking about the future of sleep diagnosis and treatment, especially when it comes to Medicare.

"Within that Medicare pie, who are you going to get the money from?" he asked. "Pulmonary's not going to give it up. Neurology is not going to give it up. The same size pie just gets readjusted." HME