Home sleep studies

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lstudt

Home sleep studies

Post by lstudt » Tue Jul 23, 2013 6:00 pm

I have a patient with a positive at home sleep study and he is being auto titrated at home as well. He compliance data shows improvement and fits within the FMCSA 70% rule, etc. My question is doesn't the driver need a full polysomnogram? I find reference to the MRB/MCSAC saying home studies "underestimate AHI" and for me to use "clinical judgement." http://ntl.bts.gov/lib/44000/44600/4463 ... 2011-p.pdf
The center that performed the at home study (not ordered by me) states he does not need any further study and his test was read by a certified sleep specialist. My thoughts have been that if a secured home study was performed and was negative, we could use that but if not negative, a full test would be next.

Thoughts?

Thank you in advance.



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Re: Home sleep studies

Post by Robert Swotinsky MD » Wed Jul 24, 2013 8:54 pm

Text from page 43 of the cited MRB Evidence Report is copied below. PM = portable monitor. Usual caveats: The MRB Board is advisory to FMCSA. Its recommendations may, or may not, eventually be adopted with or without modification. Its recommendations are educational but neither constitute official regulation or guidance.

Unless you have reason to reject the home sleep study data, I suggest you use it and appreciate that the driver and treating providers are being diligent. Give a 1 year card so that you can more closely monitor the driver.


1.1. PM for the diagnosis of OSA should be performed only in conjunction with a comprehensive sleep evaluation. Clinical sleep evaluations using PM must be supervised by a practitioner with board certification in sleep medicine or an individual who fulfills the eligibility criteria for the sleep medicine certification examination. In the absence of a comprehensive sleep evaluation, there is no indication for the use of PM.
1.2. Provided that the recommendations of 1.1 have been satisfied, PM may be used as an alternative to Polysomnography (PSG) for the diagnosis of OSA in patients with a high pretest probability of moderate to severe OSA. PM should not be used in the patient groups described in 1.2.1, 1.2.2, and 1.2.3 (those with comorbidities, other sleep disorders, or for screening).
1.2.1. PM is not appropriate for the diagnosis of OSA in patients with significant comorbid medical conditions that may degrade the accuracy of PM, including, but not limited to, moderate to severe pulmonary disease, neuromuscular disease, or congestive heart failure.
1.2.2. PM is not appropriate for the diagnostic evaluation of OSA in patients suspected of having other sleep disorders, including central sleep apnea, periodic limb movement disorder (PLMD), insomnia, parasomnias, circadian rhythm disorders, or narcolepsy.
1.2.3. PM is not appropriate for general screening of asymptomatic populations.
1.3. PM may be indicated for the diagnosis of OSA in patients for whom in-laboratory PSG is not possible by virtue of immobility, safety, or critical illness.
1.4. PM may be indicated to monitor the response to non-CPAP treatments for obstructive sleep apnea, including oral appliances, upper airway surgery, and weight loss.

lstudt

Re: Home sleep studies

Post by lstudt » Thu Jul 25, 2013 12:07 pm

Thank you. I had come to a similar conclusion after discussing the study with local providers, reviewing the test with the test administrator, etc.

Hawkeyes5

Re: Home sleep studies

Post by Hawkeyes5 » Thu Aug 01, 2013 2:55 pm

I would like to hear others' opinions regarding the use of home studies in terms of trust that the test is actually being performed on the individual in question. In other words, how do I know the CMV driver is being tested instead of his/her 19 year old son? Thanks.

lstudt

Re: Home sleep studies

Post by lstudt » Sun Aug 04, 2013 12:40 pm

Great question. We have had similar discussions. Our sleep lab has a home pulse oximetry study that we use occasionally for borderline cases lack of insurance/lack of coverage, etc. It is cheaper and is a sensitive test. Anyhow, the lab has a "chain of custody" device that will show tampering, etc., if a patient would place the device on someone else.

Last week, I spoke to another clinic and they have a more sophisticated home study with a similar device.

reba

Re: Home sleep studies

Post by reba » Tue Jan 28, 2014 12:00 am

Great question. We have had similar discussions. Our sleep lab has a home pulse oximetry study that we use occasionally for borderline cases lack of insurance/lack of coverage, etc. It is cheaper and is a sensitive test. Anyhow, the lab has a "chain of custody" device that will show tampering, etc., if a patient would place the device on someone else.

Last week, I spoke to another clinic and they have a more sophisticated home study with a similar device.

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