Medicare may allow home diagnosis of sleep apnea

With millions of dollars at stake, the debate concerning how best to diagnose sleep apnea is hardly a snore.Home testing units are cheaper and less hassle than a trip to a sleep laboratory but not as reliable in diagnosing the disorder, which restricts breathing during the night, causing sufferers to wake up repeatedly.Medicare currently covers sleep apnea treatment -- the most common is the CPAP, a mask that covers the nose and mouth, increasing air pressure in the throat during the night -- only for those diagnosed in a sleep lab.But last month it proposed to cover treatment for seniors diagnosed with home tests. A final decision is expected in March.The decision will have large ramifications for the booming sleep apnea devices market, which generated more than $85 million of revenue in 2005 and is expected to reach $135 million by 2012, according to a market research report by Frost & Sullivan."People who invested in MRIs in the '90s are investing in sleep labs in the 2000s," said Dr. Lewis Kline, director of the center for sleep disorder at Western Pennsylvania Hospital. "It's big business."If Medicare decides to support home diagnosis -- and private insurers likely would follow Medicare's lead -- it could cut into business at independent and hospital-run sleep labs.Kline estimated that a lab-run polysomnography (PSG) costs from $650 to $800, whereas a home test, once all of the costs of delivering and reading it are factored in, is about 35 percent cheaper.A growing segment of the population is in the market for such treatment.According to the National Institutes of Health, about 18 million Americans, many of whom go undiagnosed, suffer from sleep apnea.The disorder causes people to stop breathing repeatedly throughout the night -- sometimes for a minute at a time -- as throat muscles temporarily collapse. Most common in men older than 40, it causes bad snoring and affects quality of sleep, leaving sufferers groggy during the day.The traditional way to diagnose the disorder is an overnight stay at a sleep lab. Kline said he doesn't have a problem with home tests, though a 2007 study by doctors at the University of Pennsylvania concluded that they aren't as reliable as a PSG. The biggest problem with diagnosing sleep apnea, as Kline put it, is "who's reading the squiggles.""What are the controls on a home study?" he said. "Who's going to determine who's qualified to order or read these studies?"A home testing device spits out a "yes" or "no" diagnosis, Kline said, but a qualified doctor must read the raw data to be sure the machine didn't malfunction during the night. He said Medicare should mandate board certification for doctors looking at the tests."The home study thing doesn't scare me from a business viewpoint if it's done properly," Kline said."I'm looking at the care of the patients. ... Some people would say I have an agenda, but that's just what I would call good quality care."Staff writer Pohla Smith contributed. Daniel Malloy can be reached at dmalloy(at)post-gazette.com (Distributed by Scripps Howard News Service, www.scrippsnews.com.)