Finding the Value in Home Sleep Testing

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There is no denying that the climate of sleep medicine is changing. In my travels consulting with sleep centers and speaking with technologists throughout the United States, I hear a common concern regarding the impact of Home Sleep Testing (HST) – sometimes referred to as Out of Center Sleep Testing (OCST) or Portable Monitoring (PM) – on sleep medicine and, more specifically, the jobs of sleep technologists.  OCST was a large focus of discussion at the Sleep 2013 national meeting in Baltimore.  The fact that sleep technologists are concerned means they are aware.  Awareness is an essential first step. 

I prefer the term Out of Center Sleep Testing as, I believe, it opens our minds to the utility of it as practitioners. Is there value in OCST?  Let’s consider the definition of the word “value”.  According to Merriam-Webster dictionary, one definition of value is the “relative worth, utility, or importance of.”

OCST does not have to bring thoughts of doom and gloom. Use OCST as an opportunity to capture patients that your sleep center may have been previously excluding.  Let’s consider Uncle Jay who you believe to have a high-test probability of sleep apnea. He is 55 years old, BMI of 41, and neck circumference of 18 inches with no hypertension, pulmonary disease, neuromuscular disease or other comorbid condition.  He is not suspected to have PLM’s, parasomnias, narcolepsy, or central sleep apnea.  Perhaps you have been coaxing Uncle Jay to the sleep center for a PSG for many years to no avail. The thought of sleeping away from home and having a stranger ‘watch’ him sleep was enough to keep Jay away from the sleep center.  Result: Uncle Jay continues to have undiagnosed sleep apnea putting him at high risk of cardiovascular consequences such as stroke, heart disease and diabetes. Uncle Jay is a fabulous candidate for OCST and is much more likely to be agreeable to it than to traditional polysomnography. Is there relative worth, utility, or importance in OCST for Uncle Jay? I say YES!  As well as for the many other candidates who have similar circumstances.

A prospective and randomized study was published in the journal Sleep 2009 May;32(5):629-36 comparing the validity of portable monitoring with PSG.  This study concluded accuracy of portable monitoring in confirming the diagnosis of OSA where there was a high-test probability for the disorder. One key feature of this study was that the portable monitoring patients had a high level of education and support from sleep center personnel to ensure understanding of the testing process. 

Will OCST change the practice of sleep medicine?  It already has.  Does it mean bad medicine?  It doesn’t have to.  Look at this juncture as an opportunity to provide a different type of care for your patients. Expand your sleep clinic to offer a channel for advanced education, follow up and support for patients. Work with other medical disciplines to seek a new patient population who would not be willing to attend a facility-based sleep test thus expanding the scope of your practice. 

Rise to the occasion.  Be responsible.  Be attentive.  Provide excellent patient care.  All contact with our patients has relative worth, utility, AND importance.

By Mary Kay Hobby, RRT, RPSGT

President Sleep Health Management Resources, Inc.