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-