gasp hst/pm policy statement
DESCRIPTION
Georgia Association of Sleep Professionals Policy Statement Regarding Home Sleep Testing (HST) / Portable Monitoring (PM)TRANSCRIPT
President Susan Keller Yenney,
RPSGT
Presidentelect Rock Conner, RRT, RPSGT
Secretary Kim Goins, RPSGT
Treasurer Jennifer Phipps, RPSGT/RST, MBA, CPC, CHCC,
CHCO, CPAR
Clinical Board Members David Westerman, MD
Manoj Maggan, DDS
Technical Board Members Joel Porquez, BS, RPSGT/
RST
Jarrod Rowe, RPSGT
Facility Board Members Octavian Ioachimescu,
MD, PhD
Sigurjon Kristjansson
Immediate Past President Jeffrey Michaelson MD
Executive Director Maryann McGrail
[email protected] 404-310-5866
Georgia Association of Sleep Professionals
Policy Statement Regarding Home Sleep Testing (HST)/Portable Monitoring (PM)
There are currently four accepted methods for testing and screening patients suspected of having a
sleep disorder. They are as follows:
Type I Fully attended polysomnography (PSG) in a sleep laboratory setting
Type II Comprehensive, but unattended polysomnography
Type III Portable study with at least four channels, including two respiratory channels, heart
monitor and oximetry (also referred to as a cardio-respiratory study).
Type IV One or two channel (example: O2 saturation + airflow)
Background
In March of 2008, CMS recognized Home Sleep Testing (HST) as a basis to prescribe CPAP (continuous
positive airway pressure). As a result of that recognition, CMS coverage for PAP devices will be
provided for adults diagnosed with obstructive sleep apnea (OSA) if performed in conjunction with a
clinical evaluation and a positive PSG performed in a sleep laboratory or unattended home sleep
testing with Type II, III, or approved Type IV devices.
Policy
The Georgia Association of Sleep Professionals recognizes and supports the use of Type III as a valid
alternative to a PSG in selected patients with suspected OSA following the American Academy of Sleep
Medicine (AASM) guidelines for HST or Portable Monitoring (PM) published in the Journal of Clinical
Sleep Medicine, Vol3, No.7, 2007 pp. 737 – 747.
1. Indications for Usage of PM
a. Unattended portable monitors (PMs) for the diagnosis of OSA should be performed only
in conjunction with a comprehensive sleep evaluation.
b. Sleep evaluations using PMs must be supervised by a board certified or board eligible
sleep specialist.
c. PMs may be used as an alternative to PSG when there is a high pretest probability of
moderate-to-severe OSA in uncomplicated patients.
d. Since PMs are utilized in high pre-test probability of OSA populations, and given the
known rate of false negative results, negative results must be followed with definitive
Type 1 or Type 2 testing.
e. PMs may be indicated for the diagnosis of OSA where the patient is unable to have a
laboratory PSG (e.g. immobility).
f. In addition to its diagnostic utility, HSTs may be useful to monitor progress in selected
patients; e.g. following weight reduction, oral appliance therapy or after surgery.
2. PMs should NOT be utilized under the following circumstances:
a. Presence of co-morbid conditions which may degrade the accuracy of the test (e.g.
pulmonary disease, CHF, neuromuscular disease).
b. Presence of co-morbid sleep disorders (e.g. PLMD, parasomnias, insomnias, circadian
rhythm disorders, narcolepsy).
c. General screening in asymptomatic individuals,.
Technical Considerations
1. Interpretation of the PM/HST should be performed by the above mentioned appropriately
qualified sleep specialist.
2. The interpreting physician should have the ability to review the raw data and correlate the data in
clinical context.
Georgia Association of Sleep Professionals
6134 Poplar Bluff Circle, Suite 101, Norcross, Georgia 30092
tel 770-613-0932, fax 305-422-3327, www. gasleep.org
3. Sleep technologists, sleep technicians, or appropriately trained healthcare professionals must perform the
application of the PM sensors or directly educate the patient in the correct application of sensors.
4. Scoring criteria should be consistent with the current AASM standards for scoring of apneas and hypopneas.
Clinical Considerations
1. HST/PM results and therapeutic options, if indicated, should be discussed with the patient by the Sleep
Specialist. Many different types of sleep disorders present with systems consistent with OSA (excessive
daytime sleepiness, non-restorative sleep, sleep disruption). These other disorders must be taken into
consideration when developing the treatment plan.
2. The patient should receive continuing follow up care by a board certified sleep physician to ensure
satisfactory outcomes including efficacy and compliance of the selected treatment plan.
The Georgia Association of Sleep Professionals encourages each sleep center to develop policies and procedures
for the use of HST.
Policies should include:
• Indications and exclusions for patients considered for HST,
• Methodology for providing the patient tests results and follow up,
• Methodology for addressing technically inadequate studies and/or false negative results.