Polysomnography in OSA

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
M

moosa

Full Member
10+ Year Member
15+ Year Member
Joined
Dec 26, 2007
Messages
15
Reaction score
0
Hello,

I want to ask why is it necessary to get a sleep study done in a patient with clinically obvious OSA (Loud snoring/witnessed apneic spells+ hypoxemia during these spells/ gasping and choking sensations/ day time symptoms relating to OSA). Can we just do CPAP titration and start patient on CPAP accordingly. Apart from getting a documented evidence that the patient is having OSA, what are the other things that make it really important to have this test before starting patients on CPAP?
Members don't see this ad.
 
moosa said:
Hello,

I want to ask why is it necessary to get a sleep study done in a patient with clinically obvious OSA (Loud snoring/witnessed apneic spells+ hypoxemia during these spells/ gasping and choking sensations/ day time symptoms relating to OSA). Can we just do CPAP titration and start patient on CPAP accordingly. Apart from getting a documented evidence that the patient is having OSA, what are the other things that make it really important to have this test before starting patients on CPAP?
Click to expand...

Not all "OSA" is simple OSA. The first step in distinguishing this is the sleep study.
 
Members don't see this ad :)
We do spend a fair amount of time on sleep during pulm fellowship, and the pulm boards have a decent amount of sleep medicine questions (according to ABIM, 6% will be respiratory related sleep questions, and 2% will be non-respiratory related sleep questions). It's also one of the MOC modules made available at ATS and Chest (the others include pulmonary, critical care, and peds pulmonary)

I can move this thread to the sleep forum, but it's nice to have some variety of discussion, besides fellowship application/interviews.
 
moosa said:
Hello,

I want to ask why is it necessary to get a sleep study done in a patient with clinically obvious OSA (Loud snoring/witnessed apneic spells+ hypoxemia during these spells/ gasping and choking sensations/ day time symptoms relating to OSA). Can we just do CPAP titration and start patient on CPAP accordingly. Apart from getting a documented evidence that the patient is having OSA, what are the other things that make it really important to have this test before starting patients on CPAP?
Click to expand...
LOL...Looks like somebody had their dispo plan ruined by a CMS requirement.

Get used to it...payers want to know that your expensive therapy has an indication and some potential benefit. It's not a completely unreasonable request to be honest. A med student documenting "the night nurse saw this patient have an apneic episode when she bothered to wander into the room after losing a game of Candy Crush Saga on her iPhone" isn't exactly proof of OSA.
 
jdh71 said:
And the sleep folks have their OWN forum because it is it's OWN specialty, not just some "other thing" that pulmonary does.

@neurologist and @gutonc

Maybe this should get moved??
Click to expand...
First you bitch that there's no Pulm forum, then you bitch when people post in your fancy new Pulm forum. Where does it end man...where does it end?
 
group_theory said:
We do spend a fair amount of time on sleep during pulm fellowship, and the pulm boards have a decent amount of sleep medicine questions (according to ABIM, 6% will be respiratory related sleep questions, and 2% will be non-respiratory related sleep questions). It's also one of the MOC modules made available at ATS and Chest (the others include pulmonary, critical care, and peds pulmonary)

I can move this thread to the sleep forum, but it's nice to have some variety of discussion, besides fellowship application/interviews.
Click to expand...

I spent some time doing cardio and trauma in fellowship too. There's questions on the boards. I'm not a cardiologist nor a trauma surgeon.

Ask the experts.

Sleep is its own specialty.
 
gutonc said:
LOL...Looks like somebody had their dispo plan ruined by a CMS requirement.

Get used to it...payers want to know that your expensive therapy has an indication and some potential benefit. It's not a completely unreasonable request to be honest. A med student documenting "the night nurse saw this patient have an apneic episode when she bothered to wander into the room after losing a game of Candy Crush Saga on her iPhone" isn't exactly proof of OSA.
Click to expand...

This is incorrect.

THAT nurse was reading US Weekly and got to the end of "Who Wore It Best" not playing Candy Crush.
 
moosa said:
Hello,

I want to ask why is it necessary to get a sleep study done in a patient with clinically obvious OSA (Loud snoring/witnessed apneic spells+ hypoxemia during these spells/ gasping and choking sensations/ day time symptoms relating to OSA). Can we just do CPAP titration and start patient on CPAP accordingly. Apart from getting a documented evidence that the patient is having OSA, what are the other things that make it really important to have this test before starting patients on CPAP?
Click to expand...

The words you're looking for is "split night study".
 
moosa said:
Hello,

I want to ask why is it necessary to get a sleep study done in a patient with clinically obvious OSA (Loud snoring/witnessed apneic spells+ hypoxemia during these spells/ gasping and choking sensations/ day time symptoms relating to OSA). Can we just do CPAP titration and start patient on CPAP accordingly. Apart from getting a documented evidence that the patient is having OSA, what are the other things that make it really important to have this test before starting patients on CPAP?
Click to expand...

OP,

Case in point . . .

Saw a guy in clinic last week, sounded like slam dunk OSA. Sent him for the sleep study.

Comes back to see me yesterday. He's got central apnea and the CPAP made him WORSE. He required some fancier mode of NIPPV to correct his sleep architecture. I turfed him to one of my colleague for a work-up of his central apnea and follow up as it's now way outside of my wheelhouse as a plain vanilla pulmonologist.

THIS. Is why you get sleep studies on patients who are "OSA" . . . sometimes they are aren't. I'd have potentially "killed" this patient with the blind CPAP rx.
 
jdh71 said:
Sure. But that's aso abot as unecessary as starting everyonewh comes into the hospial on meropenem because . . . covers so much
Click to expand...

What's wrong with mero? If it's good enough for our CF patients, it's good enough for the general population.

Speaking of sleep, anyone seen an AHI greater than 150 yet?
 
A little late to the party, but I would also like to point out that without a sleep study you won't get the DME approved as medically necessary by the insurance company.
 
You must log in or register to reply here.
Next unread thread
Top