HOME OBSTRUCTIVE
SLEEP APNEA
MANAGEMENT IN THE
USA AND ABROAD
P. LYNN NICHOLS, M.D.
DABSM,FCCP
MEDICAL DIRECTOR
Summitsleeptn.com
Financial disclosures


I make a living as a pulmonologist
and sleep physician
No large medical company has ever
offered me any money, but I am
open to the idea
WHAT IS THE NAME OF THIS
PROCEDURE, ANYWAY?





Home Sleep Testing (HST)
Out of Center Sleep Testing (OCST)
Portable Monitoring (PM)
Limited Channel Testing (LCT)
*proposed- Home Obstructive Sleep
Apnea Management (HOSAM)
GOALS




Scientific rationale for HST
HST experience in socialized
medicine (New Zealand)
HST four year experience in private
US Sleep Center
Where is sleep disorder management
headed in the US?
SCIENTIFIC RATIONALE FOR
HST/HOSAM
NEW ZEALAND
HAKA
The Challenge
Design and implement an
obstructive sleep apnea diagnostic
and treatment program for
150,000 rural New Zealanders
NZ$100,000 SLEEP PROGRAM
OTHER RESOURCES




One respiratory therapist dedicated
to pulmonary function lab and sleep
program (I had to hire)
4 small hospitals/clinics with nursing
staff
Chartered airplane (my favorite)
Support of Auckland sleep lab
MORNING COMMUTE
IT’S ALL ABOUT THE
ALGORITHM





GP referral letter to Respiratory
Consultant
Home sleep test with follow up at next
respiratory clinic with initiation of Auto
CPAP
Auto CPAP download next CPAP clinic and
placed on cheaper fixed CPAP unit
CPAP clinic follow ups with RT
Referral to Auckland if necessary
OUTCOME AT ONE YEAR


Around 70% of patients could be
managed without in-lab study
initially
Recruited a respiratory consultant
from South Africa to continue the
programs
Home Sleep Testing
Technical Perspective
Nicole Line, RPSGT, RST,PSGP
Clinical Director
DISCLAIMER
The following slides are opinions derived
from our experiences at Summit Sleep
Services and are in no way representative
of all Sleep Center situations.
As techs, our first reaction to
HST…….
Embletta Gold by Embla
Embletta Gold by Embla
Features:
 Easy application with color coded sensors
 Pre-program multiple studies
 Rechargeable battery
 Internal position sensor
 Ability to record 12 channels
Embletta Gold by Embla
Limitations:
 Heavier unit
 Difficult for patients to apply
themselves
 Somewhat difficult to score
Nihon Kohden Nomad
Nihon Kohden Nomad
Features:
 Integrates with NK system
 Auto starts with pulse signal or can be set
to start at a designated time
 2GB internal memory
 Uses 2 AA batteries
 Has ability to monitor 12 channels:
thermister, pressure transducer, snore,
body position, SPO2, pleth, pulse, chest
effort, abdominal effort, 2 limb channels
and 1 DC output
Nihon Kohden Nomad
Limitations:
 Larger/heavier than most units
 Higher price point
 Costly to repair
 Difficult for patient to apply
themselves
SleepView by CleveMed
SleepView by CleveMed
Features:
 Cloud based
 Easy patient application
 Very light
 Capable of recording 7 channels: Pulse
oximetry, heart rate, respiratory effort,
cannula based airflow, thermister based
airflow, snore, and body position
 Uses 1 AAA battery
 All necessary study supplies included
 1 GB internal memory
SleepView by CleveMed
Limitations:
 Belt seemed to slip out of place
during recording resulting in a suboptimal signal
 Cumbersome log in/ log out process
for downloading, scoring and
interpreting in one location
Apnea Link Plus by ResMed
Apnea Link Plus by ResMed
Features:
 4 channels: nasal flow (and snore),
pulse, oxygen saturation, and
respiratory effort
 Lightweight
 Easy patient application
 Uses 2 AA batteries
 Ability to email report and recording
 Cost effective
Apnea Link Plus by ResMed
Limitations:
 No body position sensor
 No numerical values when scoring
desaturations
SUMMIT HST ALGORITHM
 Sleep physician consult and HST ordered if
appropriate
 HST interpreted
 Sleep clinic follow-up with initiation of auto-CPAP 414 if indicated
 In-lab CPAP titration if auto-CPAP fails to resolve
symptoms
 If HST nondiagnostic then either repeat HST or in-lab
study ordered
HST INTERPRETATION
TEMPLATE
Patient Name :
Account number:
Home Sleep Testing Interpretation
Patient’s reported sleep time and quality:
Quality of raw data? Good
Impression:
Fair
Poor Unacceptable
No evidence of sleep disordered breathing
Mild obstructive sleep apnea
Moderate obstructive sleep apnea
Severe obstructive sleep apnea
Other:
Plan:
Sleep clinic follow up with review of results and
initiation of autoadjusting CPAP 4-14cm H20
In-lab CPAP titration secondary to
Sleep clinic follow up with MD
Other:
Physician signature:
Date:
WHERE IS SLEEP MEDICINE
HEADED IN THE USA?
THANK YOU