Insurance carriers are pushing harder for patients to have unattended home sleep studies versus in-lab polysomnograms. Their position is that home sleep studies are more cost efficient. But is it the best care for the patient?
In our sleep center, we see a large number of patients who receive referrals for potential obstructive sleep apnea. When performing a polysomnogram, it is not uncommon to discover other sleep issues that could be missed at home. These include bruxism, parasomnias such as REM sleep behavior disorder, periodic limb movements of sleep, and abnormal brain waves indicating nocturnal seizures.
Several months ago, I tested a home monitor myself. When I awoke, I found that the machine had stopped recording two hours after the study began. I may have hit the “off” button in my sleep, but we were never sure exactly what happened. Unfortunately, this is common. Technical failures occur in as many as 20% of home-sleep studies and are probably the biggest disadvantage of leaving patients unattended. In these instances, a repeat study is necessary.
Although polysomnography is the gold standard to rule out obstructive sleep apnea, if your suspicion is strong for this disorder and the patient has no other complaints suggestive of a comorbid sleep issue, a home sleep study may be considered. If the home study does not find obstructive sleep apnea, but the patient still complains of unrefreshing sleep and fatigue, an in-lab polysomnogram will be necessary to rule out other reasons for hypersomnia.
Home sleep studies do cost less and there is a place for their use. Such instances include patients who are unable to ambulate or those who are ill and unable to travel to a sleep lab. If there are no good sleep centers located near where a patient resides, and the only concern is obstructive sleep apnea, a home sleep study may also be good option in this situation. The patient or a caregiver will need to apply the monitor, so some instruction on use and care of the instrument will be necessary.
Sharon M. O’Brien, MPAS, PA-C, works at Presbyterian Sleep Health in Charlotte, N.C. Her main interest is helping patients understand the importance of sleep hygiene and the impact of sleep on health.