Evidence Development and Coverage Advisory Committee
currently is in the process of examining the question of whether to pay
for in-home testing for the diagnosis of sleep
apnea. If approved, this could lead to a
significant loss of income for sleep specialists.
Pulmonologists can’t get a break, can they? In the 1980’s
many lung specialists faced declining income, because of the reduction
in the number of cases of tuberculosis. Then the number of
smokers began to decline, leading to reduction in smoking-related
illness. Many pulmonologists became sleep specialists, in
part to make up for the lost revenue. (Donald Dimcheff, personal
Sleep studies are complex tests, done in purpose-built labs,
and they are pretty costly. Typically, a person with
obstructive sleep apnea needs two sleep studies: one to
establish the diagnosis, another to initiate and assess the
effectiveness of treatment. A reliable in-home test would
greatly reduce the number of diagnostic tests that would need to be
done in a lab.
Using current technology, the test in the lab is more informative than
any proposed in-home test would be.
If patient routinely got the in-home test first, some of them would end
up getting equivocal or uninformative tests, and would need to get the
regular test anyway. There are a lot of issues for MEDCAC to
Personally, I like the idea of the in-home test.
Technological advances, such as infrared imaging,
seem promising. But given the current technical limitations,
I have to agree that in-home testing is not yet appropriate for routine
I do wonder, though, whether in-home testing could be useful and
appropriate for ongoing monitoring of treatment. I sometimes
see people who are already using CPAP
or BiPAP, who develop worsening of somnolence. This
always raises the question of whether the existing treatment is
working, or is sufficient, or if something else is gong on.
It would be nice to have a simple, quick, and relatively
inexpensive way to find out.
It might even make sense to do this routinely, say once per year, for
patients on established PAP therapy.