Research touts benefits of home sleep tests

Sunday, June 5, 2005

YARMOUTH, Maine -- While CMS poo-poohed the viability of in-home sleep screening for sleep apnea, a fleet of new studies in the past several weeks has billowed the sails of those who say the home is as good as the lab when it comes to screening.

Researchers at the University of Calgary in Alberta, Canada found that lab-based polysomnography is not more useful than home testing with an oximeter for identifying patients with sleep apnea. In a report published in the American Journal of Respiratory and Critical Care Medicine, they argued that home testing could safely replace polysomnography.

"And oximetry is considered the worst of the worst of sleep tests," said Dr. Terry Davidson, a sleep doctor at the University of San Diego and a supporter of portable sleep monitoring.

Davidson also participated in a study published by the journal Otolaryngology -- Head and Neck Surgery. That analysis of 1220 patients tested for sleep apnea found that patients showed less night-to-night variability in their response to sleep testing in the home when compared to sleep lab tests.

Overseas, a study by the Department of Respiratory and Sleep Medicine at Princess Alexandra Hospital in Australia looked at the possibility of bypassing polysomnography testing for sleep apnea patients.

"Current resources are inadequate to meet the demand for polysomnography, resulting in long waiting lists," stated the report. "This study aimed to evaluate the role of arbitrary CPAP as a method to reduce delays in commencing treatment."

The researchers concluded that using CPAP before laboratory tests resulted in similar improvements in patient conditions than if polysomnography had determined the exact CPAP settings. The report, also published by the American Journal of Respiratory and Critical Care Medicine, argued that this approach is useful and safe in preventing the delay of treatment if testing is not readily available.

"There is now even literature in which people went from symptoms of sleep apnea directly to CPAP and did just fine. So, maybe we won't do any sleep tests at all, only in cases that are particularly difficult," said Davidson. "The world changes."

CMS earlier this year signaled that it wouldn't sanction in-home testing because the scientific data didn't support such a move. The American Academy of Sleep Medicine lobbied for this position.

"We encourage the industry to fund some independent sleep studies, and let's see what happens. The evidence needs to be accumulated as it has in every other phase of medicine," said Jerry Barrett, executive director of the American Academy of Sleep Medicine, which argued to CMS that the evidence did not exist to support in-home testing.