Home Sleep Tests vs. In-Lab Studies

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Will Insurance Pay for an
In-Lab Sleep Study?
Home Sleep Tests
vs.
Rest assured, we’ll handle that!
Floyd Memorial Sleep Disorders Center experts
work with insurance companies every day to obtain
pre-authorizations for sleep studies. We will make
the necessary calls and arrangements to satisfy the
insurance requirements to obtain authorization
before the patient is scheduled for a sleep study.
Monitored In-Lab
Sleep Studies
All we need is the physician referral,
and we’ll take it from there.
Our office handles the entire process from the
initial evaluation by a board certified sleep
specialist, through the comprehensive sleep study
and, if indicated, fitting the patient for a CPAP
machine. We also perform the CPAP titration
study and complete the required DME (durable
medical equipment) orders required by insurance
companies to cover the cost of the equipment.
The accredited sleep experts at the
Floyd Memorial Sleep Disorder Center can help
you, or your patients, get a good night’s sleep.
Call (812) 949-5550 to make
an appointment today.
1850 State Street
New Albany, IN 47150
313 Federal Drive NW, Suite 040
Corydon, IN 47112
(812) 949-5550
www.floydmemorial.com/sleep
For Patients and Physicians
Discovering the Differences Between
Home and In-Lab Sleep Studies
You may have noticed home study providers are
becoming more prevalent in our area. There are
major differences betwen the home sleep tests
they provide and the traditional in-lab sleep
studies administered in accredited facilities. This
brochure will explain the important differences
between the two types of sleep study.
Home Testing May Produce
Less than Optimal Results
Because home testing relies upon the patient
to correctly place the monitoring equipment on
themselves, many overnight studies have suboptimal
results. The patient may incorrectly place the monitors
on themselves, or during their sleep, accidentally remove
or shift the position of the equipment to give false
readings, or no readings at all. Frequently, home studies
require multiple nights of monitoring to achieve one full
night with potentially usable data. When a patient has
an in-lab monitored sleep study, the trained technician
ensures the accurate placement of the equipment and
can immediately correct or replace the monitors if the
patient knocks them off or dislodges the placement.
This allows “clean” results and greater data accuracy.
Chain of Custody
The Department of Transportation has been increasing
the mandatory testing of commercial drivers for
obstructive sleep apnea (OSA) and other sleep disorders.
Many professional drivers fearful of losing their
licenses may seek to fake a ‘passing grade’ on their
sleep evaluation. There are patients who have been
known to place home sleep study equipment onto
their spouses or children in order to avoid detection
of a sleep disorder. Some patients may also wear the
equipment, but stay awake all night, in order to hide
any breathing issues related to a sleep disorder.
Only an in-lab study has the capability to fully monitor
the patient to ensure accurate identity and results.
False Negatives
Studies have shown that people are not able to
accurately determine how long it takes to fall asleep,
how long they slept, if they had REM sleep (dreaming)
or how often they awaken during the night. Most home
sleep tests do not include EEG (electroencephalogram)
testing which measures electrical activity of the
brain, and only rely upon the patient’s guesses as to
how much and what type of sleep they might have
had. OSA is more severe during REM sleep in most
patients. Some will only have sleep apnea during REM
sleep, and not during any other stage of sleep. If the
patient didn’t have much sleep during the study, or
didn’t have REM sleep, the sleep test may result in
a false negative. Only a full diagnostic in-lab sleep
study can ensure proper electrode placement and
accurate determination of sleep stages, total sleep time,
sleep disturbances and the presence of REM sleep.
False negative studies often result
in serious sleep disorders going
undiagnosed and untreated.
Studies have also shown that OSA is almost always
more severe in the supine (back) sleeping position. Many
types of home testing equipment do not monitor the
patient’s position during sleep. Even when the home
testing equipment is recording the patient’s position, the
data may not be correct because the position monitor
may slip during the night, possibly indicating the
patient slept on their back, when in fact they were on
their side. In-lab, monitored sleep studies have trained
technicians monitoring and correcting the position
for the patient so the study will accurately determine
the severity of OSA while sleeping on the back.
Situations When Home Tests
Should Not Be Administered
Because of the limited and possible inaccuracy of
the data from home studies, the American Academy
of Sleep Medicine advises that patients with the
following conditions should not have a home study.
These patients should only have
in-lab, monitored sleep studies:
Patients with another significant
medical condition including:
•Congestive heart failure
•Neuromuscular disease
•Moderate to severe pulmonary disease
Patients suspected to have other
sleep disorders such as:
•Central sleep apnea
•Periodic limb movement disorder
•Insomnia
•Parasomnias
•Narcolepsy
What if a Patient Requires
or Wants a Home Study?
While many home study providers have appeared
in recent years, few meet the exacting standards
set forth by the American Academy of Sleep
Medicine (AASM) to achieve accreditation.
The Floyd Memorial Sleep Disorders Center is one
of the few providers who have met these standards
and is accredited by the AASM to perform out-ofcenter (home) sleep studies if they are required. Some
insurance companies will not approve a full in-lab study
if a patient does not have certain medical conditions.
In this situation, we are able to provide a home study
that is scored by a registered polysomnographer and
read by an AASM diplomate to provide the most
accurate results for diagnosing a sleep disorder.