President Susan Keller Yenney,

RPSGT

Presidentelect Rock Conner, RRT, RPSGT

Secretary Kim Goins, RPSGT

Treasurer Jennifer Phipps, RPSGT/RST, MBA, CPC, CHCC,

CHCO, CPAR

Clinical Board Members David Westerman, MD

Manoj Maggan, DDS

Technical Board Members Joel Porquez, BS, RPSGT/

RST

Jarrod Rowe, RPSGT

Facility Board Members Octavian Ioachimescu,

MD, PhD

Sigurjon Kristjansson

Immediate Past President Jeffrey Michaelson MD

Executive Director Maryann McGrail

mbmcgrail@gasleep.org 404-310-5866

Georgia Association of Sleep Professionals

Policy Statement Regarding Home Sleep Testing (HST)/Portable Monitoring (PM)

There are currently four accepted methods for testing and screening patients suspected of having a

sleep disorder. They are as follows:

Type I Fully attended polysomnography (PSG) in a sleep laboratory setting

Type II Comprehensive, but unattended polysomnography

Type III Portable study with at least four channels, including two respiratory channels, heart

monitor and oximetry (also referred to as a cardio-respiratory study).

Type IV One or two channel (example: O2 saturation + airflow)

Background

In March of 2008, CMS recognized Home Sleep Testing (HST) as a basis to prescribe CPAP (continuous

positive airway pressure). As a result of that recognition, CMS coverage for PAP devices will be

provided for adults diagnosed with obstructive sleep apnea (OSA) if performed in conjunction with a

clinical evaluation and a positive PSG performed in a sleep laboratory or unattended home sleep

testing with Type II, III, or approved Type IV devices.

Policy

The Georgia Association of Sleep Professionals recognizes and supports the use of Type III as a valid

alternative to a PSG in selected patients with suspected OSA following the American Academy of Sleep

Medicine (AASM) guidelines for HST or Portable Monitoring (PM) published in the Journal of Clinical

Sleep Medicine, Vol3, No.7, 2007 pp. 737 – 747.

1. Indications for Usage of PM

a. Unattended portable monitors (PMs) for the diagnosis of OSA should be performed only

in conjunction with a comprehensive sleep evaluation.

b. Sleep evaluations using PMs must be supervised by a board certified or board eligible

sleep specialist.

c. PMs may be used as an alternative to PSG when there is a high pretest probability of

moderate-to-severe OSA in uncomplicated patients.

d. Since PMs are utilized in high pre-test probability of OSA populations, and given the

known rate of false negative results, negative results must be followed with definitive

Type 1 or Type 2 testing.

e. PMs may be indicated for the diagnosis of OSA where the patient is unable to have a

laboratory PSG (e.g. immobility).

f. In addition to its diagnostic utility, HSTs may be useful to monitor progress in selected

patients; e.g. following weight reduction, oral appliance therapy or after surgery.

2. PMs should NOT be utilized under the following circumstances:

a. Presence of co-morbid conditions which may degrade the accuracy of the test (e.g.

pulmonary disease, CHF, neuromuscular disease).

b. Presence of co-morbid sleep disorders (e.g. PLMD, parasomnias, insomnias, circadian

rhythm disorders, narcolepsy).

c. General screening in asymptomatic individuals,.

Technical Considerations

1. Interpretation of the PM/HST should be performed by the above mentioned appropriately

qualified sleep specialist.

2. The interpreting physician should have the ability to review the raw data and correlate the data in

clinical context.

Georgia Association of Sleep Professionals

6134 Poplar Bluff Circle, Suite 101, Norcross, Georgia 30092

tel 770-613-0932, fax 305-422-3327, www. gasleep.org

3. Sleep technologists, sleep technicians, or appropriately trained healthcare professionals must perform the

application of the PM sensors or directly educate the patient in the correct application of sensors.

4. Scoring criteria should be consistent with the current AASM standards for scoring of apneas and hypopneas.

Clinical Considerations

1. HST/PM results and therapeutic options, if indicated, should be discussed with the patient by the Sleep

Specialist. Many different types of sleep disorders present with systems consistent with OSA (excessive

daytime sleepiness, non-restorative sleep, sleep disruption). These other disorders must be taken into

consideration when developing the treatment plan.

2. The patient should receive continuing follow up care by a board certified sleep physician to ensure

satisfactory outcomes including efficacy and compliance of the selected treatment plan.

The Georgia Association of Sleep Professionals encourages each sleep center to develop policies and procedures

for the use of HST.

Policies should include:

• Indications and exclusions for patients considered for HST,

• Methodology for providing the patient tests results and follow up,

• Methodology for addressing technically inadequate studies and/or false negative results.