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1. Who should decide whether or not HST is appropriate for a patient?
The patient's physician should determine the appropriateness of HST vs. in-center polysomnography (PSG) using clinical assesment and evidence presented by the patient.
2. Is HST appropriate for diagnosis of OSAS (Obstructive Sleep Apnea Syndrome) in all patients?
No, HST is not appropriate for children and the following populations:
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HST is not appropriate for the diagnosis of OSA in patients with significant comorbid conditions that may degrade the accuracy of HST, including, but not limited to moderate to severe pulmonary disease, neuromuscular disease or congestive heart failure.
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HST is not appropriate for the disgnostic evaluation of OSA in patients suspected of having other sleep disorders, including central sleep apnea (CSA), periodic leg movement disorder (PLMD), insomnia, parasomnias, ciracadian rhythm disorder or narcolepsy.
3. What should I do if the HST results are inconclusive or negative?
Negative or technically inadequete home sleep tests in patients with a high pre-test probabilty of moderate to severe OSA should prompt in-center polysomnography (PSG)
4. What clinical guidelines can I refer to when evaluating HST as an option for my patients?
Please refer to the industry standards published in the Journal of Clincial Sleep Medicine www.aasmnet.org/jcsm. Collop NA; Anderson WM; Boehlecke B; Claman D; Goldberg R; Gottlieb DJ; Hudgel D; Sateia M; Schwab R. Clinical guidelines for the use of unattended portable monitors in the diagnosis of obstructive sleep apnea in adult patients. J Clin Sleep Med 2007;3(7):737–747.
5. Does Medicare cover HST?
Yes. In 2005, the Centers for Medicare & Medicaid Services (CMS) published National Coverage Determinations (NCD) for home sleep testing and in 2008 published changes to the coverage for CPAP therapy for OSA to include a positive diagnosis of OSA made using a home sleep test under specified criteria. These criteria include:
- AHI or RDI greater than or equal to 15 events per hour, or
- AHI or RDI greater than or equal to 5 events and less than or equal to 14 events per hour with documented symptoms of excessive daytime sleepiness, impaired cognition, mood disorders or insomnia, or documented hypertension, ischemic heart disease, or history of stroke.
- AHI and/or RDI may be measured by polysomnography (PSG) in a facility-based sleep study laboratory, or by a Type II home sleep test (HST) monitor, a Type III HST monitor, or a Type IV HST monitor measuring at least 3 channels
Source: www.cms.gov Centers for Medicare & Medicaid Services, Department of Health & Human Services, CMS Manual System Pub 100-03 Medicare National Coverage Determinations. July 3, 2008 Change Request 6048
