Over 18 million American adults have moderate to severe Obstructive Sleep Apnea (OSA) and risk factors for hypertension and Type II Diabetes (Source: NHLBI, Am Sleep Apnea Assn). Aetna seeks to ensure better management of patients with OSA.

What are the advantages of a home sleep test?

We believe home sleep tests offer increased access to care for patients with OSA. Patients who have OSA face significant risks for cardiovascular disease and other ailments. A large, potentially undiagnosed patient base exists for OSA (estimated at more than 43 million). Home sleep tests are a clinically proven method that can address the medical needs of this patient base in their natural sleep environment, while simultaneously providing a more accurate assessment of sleep disordered breathing compared to in-lab polysomnogram (PSG).

Advantages to physicians include:

• More direct involvement in your patient's care.
• Faster results will be available to you. Many "at home" sleep vendors offer results in as few as five days. Patients are usually treated and on therapy in less than a week, compared with months later in many sleep programs.

Advantages to patients include:

• The cost of a home study can be anywhere from one-third to one-tenth of the cost of an in-lab study, depending on the provider. As employers shift more health care costs to their employees, many patients are now facing higher copays and deductibles.
• The capacity and cost of sleep labs limit efficient OSA detection.
• Patients prefer to be tested in the comfort and familiarity of their own homes, with no one watching them from another room.
• The home sleep test device is mailed to the patient with complete instructions and a toll-free technical support line 24/7.

What is the clinical support for home sleep tests?
CMS National Coverage Determinations in 2009 resulted in coverage of home sleep tests by Medicare - "these tests are thus reasonable and necessary" ¹ prompted by a letter from the American Academy of Otolaryngology - Head and Neck Surgery, who stated:
"Home sleep testing is a validated alternative and an important step in improving recognition and control of OSA"...and further that "the current paradigm of high reimbursement for PSG and low reimbursement for treatment is not only a waste of precious resources, but also discourages more appropriate focus on rapid diagnosis and effective treatment for OSA."¹
A comprehensive 2007 Agency for Healthcare Research and Quality assessment of validation and outcomes studies demonstrated strong correlation and equivalent outcomes between home sleep tests and PSG².

Who is a candidate for a home sleep test?
Home sleep tests are intended for patients who present with clinical symptoms of OSA. Patients with other sleep disorders (for example, narcolepsy, epilepsy, parasomnias), co-morbid conditions, which may impact the diagnostic relevance of the SaO2 data (such as severe heart failure, moderate to severe lung disease and obesity hypoventilation syndrome), and patients who are only mildly suspected of sleep apnea (for example, snoring without daytime sleepiness or witnessed pauses in breathing or choking during sleep) may not be candidates for a home sleep test. Patients with hypertension or diabetes are candidates, as are those that present with symptoms of insomnia. Appropriate candidates maybe determined via a sleep probability test, such as the Epworth Sleepiness Scale or Berlin Questionnaire, which maybe conducted with a patient's doctor or under his/her advice.

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REFERENCES

1. Medicare announces final coverage policy for sleep testing for the diagnosis of obstructive sleep apnea http://www.cms.hhs.gov/apps/media/press/release.asp?Counter=3428
2. Agency for Healthcare and Research Quality, Technology Assessment. Home diagnosis of Obstructive Sleep Apnea-Hypopnea Syndrome. Tufts-New England Medical Center EPC, 2007. Technology Assessment Program.