Portable Devices Used for Home Testing in Obstructive Sleep Apnea

Jeffrey A. Tice, M.D.

May 18, 2010

Recommendations of Others

Blue Cross Blue Shield Association (BCBSA)
The BCBSA Technology Evaluation Center Medical Advisory Panel has not conducted a formal review of this topic.

Centers for Medicare and Medicaid Services (CMS)
The CMS issued a National Coverage Determination on March 3, 2009 which allows for coverage of Type 1, II, III or IV devices for the diagnosis of Obstructive Sleep Apnea.
https://www.cms.hhs.gov/mcd/viewdecisionmemo.asp?from2=viewdecisionmemo.asp&id=227&

American Academy of Sleep Medicine (AASM)
From the AASM web site:
Using evidence review and a consensus process, the AASM task force developed clinical guidelines that were approved by the AASM board of directors and published in the December 15, 2007, issue of the Journal of Clinical Sleep Medicine. The guidelines recommend the use of PM by AASM-accredited sleep disorders centers and labs under the direction of a board-certified sleep specialist for the diagnosis of OSA in select adults. The guidelines are available at: https://www.aasmnet.org/Resources/ClinicalGuidelines/030713.pdf

California Thoracic Society (CTS)
A CTS representative attended the meeting to provide opinion and participated in discussion regarding this technology.

American College of Cardiology, California Chapter (CA ACC)
A CA ACC representative attended the meeting to provide an opinion regarding the use of this technology.

Agency for Healthcare Research and Quality (AHRQ)
An AHRQ Technology Assessment: Obstructive Sleep Apnea-Hypopnea Syndrome: Modeling different diagnostic strategies dated December 4, 2007 is available at: https://www.cms.hhs.gov/determinationprocess/downloads/id50TA.pdf

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Abbreviation Notes

CTAF : California Technology Assessment Forum; CMS : Centers for Medicare and Medicaid Services; CPAP : Continuous positive airway pressure; OSA : Obstructive sleep apnea; AHI : Apnea-hypopnea index; PSG : Polysomnography; EEG : Electroencephalography; EOG : Electro-oculography; ECG : Electrocardiography; RDI : Respiratory disturbance index; PM : Portable monitors; DARE : Database of Abstracts of Reviews of Effects; BMI : Body mass index; ESS : Epworth Sleepiness Scale; SAQLI : Sleep Apnea Quality of Life Index; FOSQ : Functional Outcomes of Sleep Questionnaire; BDI : Beck Depression Index; VA : Veteran’s Administration; ARES : Apnea Risk Evaluation System

Cite this: Portable Devices Used for Home Testing in Obstructive Sleep Apnea - Medscape - May 18, 2010.

Table. Summary of Clinical Trials of Home Diagnosis for Obstructive Sleep Apnea
Study	Group		Age, years	F, %	BMI kg/m2	ESS	AHI or RDI	OSA def.	OSA, %	CPAP attempted, %	CPAP continued, %	CPAP, hrs/night	Nights > 4 hours use, %	Residual AHI	Change ESS	Change FOSQ	Change SAQLI
Randomized Trials
Whitelaw 2005	Home PSG	156 132	47 47		31.8 32.1	11.6 11.6	16.6 26.0	NA	NA	100 100	82 82	3.3 3.8	56 62	4.2 5.7	-3.4 -4.0	NR	.82 .92
Mulgrew 2007	Home PSG	33 35	55 52	21 25	39 38	14 14	27 31	RDI≥15	89	100 94	94 86	6.0 5.4	NR	2.5 3.2	-8.0 -10.0	NR	1.9 2.2
Townsend 2007	Home PSG	50 53	44.1 43.8	22 24	34.2 33.2	14.3 12.0	28.3 38.0	RDI > 15 or RDI >5 and ESS > 10	86 87	70* 85	40* 49	4.0 5.1	NR	NR	-5.8 -6.0	1.1 1.8	NR
Berry 2008	Home PSG	53 53	51.9 55.1	13 11	34.0 34.4	16.6 16.2	29.2 36.8	AHI≥5	96 91	85 81	75 74	5.2 5.2	72 67	3.5 5.3	-6.5 -7.0	3.1 3.3	NR
Cohort Studies
Rice 2006	“Home”	106	59.9	0	33.5	13.1	31	AHI ≥ 5	90	87	77	NR	84	NR	-4.0	NR	NR

* 8 patients with oxygen saturation < 80% dropped from the home diagnosis group.
F : Female; OSA : Obstructive sleep apnea; PSG : Polysomnography; BMI : Body mass index; CPAP : Continuous positive airway pressure; NA : Not applicable; ESS : Epworth Sleepiness Scale; FOSQ : Functional outcomes of sleep questionnaire; NR : Not reported; AHI : Apnea-hypopnea Index; SAQLI : Sleep apnea quality of life index; RDI : Respiratory Distress Index

Additional Diagnostic Studies Reviewed

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