Dental Sleep Medicine Insider January 2015 | Page 6
As a clinician and educator for over two dec-
HST in my
Practice
with Dr. Payam Ataii
ades, I have had the pleasure of witnessing the astonishing evolution of the
Sleep Medicine field. For many, dental
sleep medicine is a new opportunity
for them to change the way their
practice treats patents. I’m just one
dentist, but for me, the ability to
screen and offer patients oral devices broadens my experience
while greatly improving my career
satisfaction. It’s not often that a
patient comes in and says, “Hey
Doc, I need a mandibular advancement device” BUT about
10% of your adult patients of record would probably benefit from
one. This is precisely why I stress
the importance of proper screening and testing.
Until just a few years ago, medicine
saw limited use of home sleep test
devices on a large scale but today, a
Polysomnography (PSG) is seldom
considered to be the ‘gold standard’
test for OSA. The industry is experiencing a continued increase in the use of
home sleep testing with utilization surpassing traditional in-laboratory PSG
soon. With new companies constantly entering to the market, it can be difficult to
determine what makes sense for the practice and who delivers on their commitments to you and your patients .
PSG vs. HST
The first of the testing methods I’ll touch on is the Polysomnography (PSG), the traditional ‘gold standard’ according to many in the industry (O’Brien, 2012), is a sleep study that is usually performed in a sleep
lab or a hospital and is ‘attended’ or observed by a Registered Polysomnogram
Technician (RPSGT). A PSG, is used to diagnose sleep apnea among other sleep disorders
including bruxism, parasomnias such as REM sleep behavior disorder, periodic limb movements, and abnormal brain waves indicating nocturnal seizures. Some of
these disorders cannot be detected by typical Home Sleep Tests (HST). Patients must complete testing inside the facilities of a lab or hospital and in some instances
there is medical
reason to have the patient monitored in the lab/hospital setting i.e. Patient
requires oxygen
and bi-level PAP therapy. Unfortunately, the costs associated with PSG are
rather high, patients in outlying areas may experience difficulty locating a facility nearby,
and patient acceptance is rather low due to the high number of leads and unfamiliar
setting.
The second method of testing is the Home Sleep Test. The HST is a sleep
study that can be
performed in the patient’s home and is used to diagnose obstructive sleep
apnea. Home
sleep studies have been used for years overseas, but the United States have
considered HST
experimental and required attended in-lab PSG to diagnose Obstructive
Sleep Apnea. In
2008, Medicare changed their stance on HST and shortly after, private insurance companies followed suit. This has resulted in increased access to care for patients
and lower costs
for payers. One of the palpable advantages that Home Sleep Tests have over a traditional Polysomnography is patient
convenience. Incorporating HST into my practice has been met with very favorable feedback from my patients because of the comfort and ease of the process. The accuracy has been fine and I have not experienced the need for re-