December 2007

Section Names Specialty Practitioner of the Year
The Sleep Section would like to congratulate Suzanne Bollig, RRT, RPSGT, on her receipt of our 2007 Specialty Practitioner of the Year Award. Suzanne was presented with the award during the AARC International Respiratory Congress in Orlando.

AASM Publishes Clinical Guidelines on Unattended Portable Monitors; MedCAC Transcript Released; CMS Issues Memorandum
The American Academy of Sleep Medicine has published new Clinical Guidelines for the Use of Unattended Portable Monitors in the Diagnosis of Obstructive Sleep Apnea in Adult Patients in the December 15 edition of the Journal of Clinical Sleep Medicine. The guidelines were developed by a Task Force and are based on a review of the available literature and expert consensus. READ ABSTRACT

The Centers for Medicare and Medicaid Services has also released the transcript of the Medicare Evidence Development & Coverage Advisory Committee (MedCAC) panel hearing on the advisability of adopting home testing for the diagnosis of OSA. The transcript includes the testimony of AARC member David Gourley, RRT, who verbalized the AARC’s written comments on the need for specific qualifications for all personnel performing sleep testing, regardless of the setting.

He told the group: “The key point that the AARC would like to make to this committee today is with regards to amending the coverage under Medicare as follows: Polysomnography must be performed by qualified personnel, such as registered polysomnographic technologists, licensed and credentialed respiratory therapists, specially trained nurses or other healthcare professionals who have been competency-tested by nationally recognized accreditation entities, and under the supervision or oversight of a board certified physician holding a sleep specialty credential.” READ THE TRANSCRIPT

At press time, CMS had just issued the long-awaited decision memorandum, proposing to expand coverage of CPAP to include beneficiaries with diagnoses made "using a combination of a clinical evaluation and unattended home sleep monitoring using a Type II, III or IV device." READ PROPOSED DECISION MEMO

CPAP Eases Depression
A new study out of the Sleep Center at University Community Hospital in Tampa, FL, finds CPAP patients who show symptoms of depression on the Beck Depression Inventory-Fast Screen for Medical Patients prior to initiation of CPAP see a marked decrease in depressive symptoms following CPAP treatment. The research involved obstructive sleep apnea patients with a respiratory disturbance index (RDI) of at least 15 who demonstrated at least a 50 percent or greater drop in RDI in response to CPAP. The finding held true over the long term too. Patients were still relieved of depressive symptoms one year later. The research was published in a recent issue of the Journal of Clinical Sleep Medicine. READ ABSTRACT

People Don’t Sleep as Long as They Think
People tend to overestimate the amount of time they spend sleeping, report researchers who compared self-reported sleep times before sleep testing and on the morning after sleep testing with total sleep time and sleep onset latency obtained from unattended home PSG. Mean habitual sleep time (HABTST) was 422 minutes, morning estimated sleep time (AMTST) was 379 minutes, and PSG total sleep time (PSGTST) was 363 minutes. The mean habitual sleep onset latency was 17 minutes, the morning estimated sleep onset latency was 21.8 minutes, and the PSG sleep onset latency was 16.9 minutes. The authors conclude, “Models adjusting for related demographic factors showed that HABTST and AMTST differ significantly from PSGTST by 61 and 18 minutes, respectively. Obese and higher educated people reported less sleep time than their counterparts. Similarly, small but significant differences were seen for sleep latency.” The study appeared in a recent issue of the Journal of Clinical Sleep Medicine. READ ABSTRACT

Noninvasive Technology Shows Promise
Texas researchers report good results for a noninvasive technology designed to replace traditional methods used in sleep testing. The remote infrared imaging camera records heat signals expired from the nostrils or mouth and was tested in 13 men and women without known sleep apnea. Results were then compared to findings from conventional methods, including nasal pressure, nasal-oral thermistors, and capnography. The remote camera detected 20 sleep-disordered breathing events versus 22 events detected by the nasal-oral thermistor and 19 events detected by nasal pressure, leading the investigators to conclude the camera was in near-perfect agreement with the traditional methods. While more study is needed, the researchers believe this technology will have a future in sleep testing. The study was presented at CHEST 2007. READ PRESS RELEASE