'It has been tough to get a CPAP machine'
Dr. Terence Davidson, a head and neck surgeon who leads the sleep lab at the University of San Diego's School of Medicine, has long been an advocate of at-home sleep tests. Davidson believes strongly that the American Academy of Otolaryngology's request that CMS review its CPAP policy will lead to coverage for beneficiaries. HME News talked to him recently to discuss this latest coverage analysis.
HME News: If CMS decides in favor of in-home sleep testing, what effect will that have?
Davidson: I think it will greatly improve access for Medicare patients to obtain home sleep testing. Some are unable to get tested simply because sleep labs are backlogged. Some don't drive at night and don't choose to spend the night in a hospital bed unless they absolutely have to. So many who are recommended for sleep testing simply won't go. I also believe that Medicare is going to be looking not only at some sleep testing but also improving paradigms to make treatment more efficient.
HME: More efficient how?
Davidson: I think that it has been tough to get to a CPAP machine. Not only is it tough to get a sleep test, but if it's positive, you have to go back for another one to have a titration, which is kind of silly because there are auto-titrating machines. If you have an auto-titration machine, you don't need a CPAP titration because the machine sets the right pressure minute by minute. If you allow an individual to be diagnosed by a home sleep test, they can go straight to APAP--hopefully without a long delay. With a CPAP, (the patient waits for a machine) four to six weeks, long after the doctor's words about how the disease is going to kill you and the machine is going to save you have been forgotten.
HME: Could in-home testing result in more accurate diagnosis?
Davidson: When I actually started this, I went out to prove that home sleep studies were better than polysomnography. And I was looking for any excuse to say they were better. The problem is, they all came out with the exact same numbers.
HME: Do you have any concerns about the request to shorten the length of a sleep study?
Davidson: No one has ever validated the concept of doing a shortened sleep test, so no one has compared a two-hour sleep test to a full-night sleep test. I don't think you get a great sleep study, and I don't know that you get the optimum CPAP titration. Nonetheless, if it's clear in the first hour that it's sleep apnea, it's fine by me.