Home Sleep Home
A Low-Cost Alternative to Full-Service Sleep Labs
By Susanna M. Virden
More than 12 million Americans suffer from sleep-disordered breathing, according to the National Institutes of Health. Yet many don’t realize that the condition can be diagnosed easily from the comfort and security of their own beds. Advances in technology, research and reimbursement have opened the doors to home sleep studies.
A comprehensive lab is unnecessary to detect sleep-disordered breathing, says David Walsh, RRT, director of the Apnea Diagnostics Program at Swedish Covenant Hospital, Chicago. All you need is “an electrical outlet and a cooperative, compliant and coherent patient” to be able to perform a limited-channel sleep test.
In his program, Walsh uses compact multi-physiologic recording devices that monitor only four to six channels of data related to sleep-disordered breathing. “The top three-quarters of the polysomnography tracing is going to be something to do with neurologic or neuromuscular data. The bottom quarter has to do with breathing, cardiac, saturation, etc.” Breathing disorders show up here.
“If you take a 24-channel poly machine into the home when the person has complained of (only) breathing pauses and snoring, that is overkill,” Walsh says. “That’s a waste of money.”
And, limited-channel testing frees up precious lab space for those patients who require full polysomnography. “I’ve got people who wait weeks and maybe a month or more to get an appointment (in a lab). I can use one of these recorders and be out there tonight or the next day.” He says one tech or therapist can carry and set up the equipment and easily handle two to three patients in an evening.
Another major advantage is alternate-site studies can cost less than half of what a lab charges, Walsh says. It’s more cost-effective for a nursing home to do a sleep study on site rather than incur the expense of transporting a patient back and forth to a sleep lab.
People also tend to sleep better in their home environments. “They are comfortable, confident, and they feel safe,” Walsh says. “Study after study, when I’ve done it here in the hospital, it’s unacceptable. Then, I do it when I get (the patient) home. I look at the two, and it’s a no-brainer.”
Sleep professionals who still cling to the lab-only world are doing a disservice to their patients at risk for sleep-disordered breathing when a readily available and accurate option exists, Walsh asserts. “To me, this is by far the best way to get testing done in a cost-efficient manner for sleep-disordered breathing. The reliability of the studies is there. I can give as good or better results than I can in a sleep lab.”
However, some question these results because in most cases a home sleep study is conducted in an unattended, uncontrolled environment. A respiratory therapist prepares the patient and the equipment, leaves for the night and returns the following morning for data collection.
“In a personal residence, there are a lot of factors that are beyond the sleep tech’s control,” says Troy Stentz, owner and operations manager of Somnos Laboratories Inc., Lincoln, Neb. Examples include disruptive bed partners, noise, children, pets, even bugs. He prefers to work in the lab or in large facilities where the integrity of space is less of an issue.
Walsh agrees that some patients may be better served in an attended situation. With experience and pointed questions during the screening process, he says, it’s easy to determine who is a poor candidate for home testing.
But if you have a cooperative client, he says, many obstacles to a valid test can be eliminated through patient education. For example, providers can instruct patients to reconnect loose leads whenever possible.
Also at issue is signal quality when using unfamiliar power sources. To ensure maximum results from the equipment, Walsh advises techs to verify a strong signal before the test begins. “You have very much increased the odds that you’ll have good data,” he says.
The incidence of repeat tests is low, Walsh says. “Even if you do have a study that doesn’t turn out right, you’re not out any big cost (compared to polysomnography).”
Insurance companies must weigh the pros and cons of home sleep studies before they agree to reimbursement.
“It’s a catch-22,” Stentz says. “They’re not getting the most bang for the buck. On the other hand, a sleep study (in a lab) is a very expensive procedure, very labor-intensive and time-consuming. Doing it at home and not having to pay for someone to attend it all night long certainly reduces the costs quite a bit.”
He predicts that managed care will continue to “crunch down the costs” of sleep testing, leaving unattended home studies as the only alternative.
Walsh believes increased research and awareness will define compact monitoring as a separate entity from polysomnography and open the pocketbooks of third-party payers. “We yearn to have more research into the outcomes associated with using compact recording,” he says. Once this happens, “they’re going to validate that it is indeed effective and that the results are reliable and have specificity for them.”
Limited-channel testing isn’t for everyone, but for those with a high probability of sleep-disordered breathing, there’s no place like home.
Susanna M. Virden is a former ADVANCE staff member.