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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.
