The debate continues about which may be the most cost effective way to diagnose sleep apnea, home respiratory polygraph (HRP) verses polysomnography (PSG). Insurers have been quick to jump on the side of HRP, primarily because of the reduced cost involved in a home study verses one in a sleep laboratory. Patients have also pushed for home testing for convenience. Let’s look at both sides of this coin.
HRP can be accurate in patients who are clinically found to be at high risk for sleep apnea, but some patients are missed with this technique and; therefore, do not receive the needed treatment (CPAP). Many of the patients with a positive home study will still need a so-called “titration study” in a sleep lab to determine the pressure needed to overcome their obstructive sleep apnea. More patients are being placed on auto-titratable CPAP and can avoid this sleep lab study, if their insurance will pay for the auto-titratable CPAP machine.
In-lab polysomnography is less convenient for some patients. It has been the industry standard. Unlike HRP, PSG can be used for patients with severe COPD, histories of heart failure, and unstable cardiovascular disease, among other co-morbid conditions. The reason for this is that the PSG is supervised by trained sleep technicians that can intervene during the sleep period if serious events are noted.
At the Lung Disease Center our Sleep Disorder Network can provide both of these testing techniques based on your insurance and clinical situation.