CleveMed Blogs

Once more, we continue our video series of Q & A with Dr. Joseph Golish on Current & Emerging Trends in Sleep Medicine. This week’s topic of discussion is The Role of Home Sleep Testing in Long Term Disease Management of Obstructive Sleep Apnea.

Dr. Golish, is a board-certified specialist in sleep medicine and author of more than 300 publications on sleep. He is a member of the Sleep Steering Committee for the ACCP. After 35 years as a professor in The Cleveland Clinic and Co-Director of Sleep Medicine, he has left academic medicine to advance a new paradigm in sleep medicine, focusing on accessibility and affordability. His goals are the proper use of HST and fostering continuity of care, in an efficient and cost-effective manner, while preserving high quality. He is currently the Medical Director of Cleveland Medical Devices (CleveMed) and Director of Sleep Center, North Coast Clinical Trials, in Cleveland, Ohio.

This week, we continue our video series of Q & A with Dr. Joseph Golish on Current & Emerging Trends in Sleep Medicine. Here’s the BIG question: Will Home Sleep Testing Replace the Sleep Center?

Dr. Golish, is a board-certified specialist in sleep medicine and author of more than 300 publications on sleep. He is a member of the Sleep Steering Committee for the ACCP. After 35 years as a professor in The Cleveland Clinic and Co-Director of Sleep Medicine, he has left academic medicine to advance a new paradigm in sleep medicine, focusing on accessibility and affordability. His goals are the proper use of HST and fostering continuity of care, in an efficient and cost-effective manner, while preserving high quality. He is currently the Medical Director of Cleveland Medical Devices (CleveMed) and Director of Sleep Center, North Coast Clinical Trials, in Cleveland, Ohio.

A sleep study (also called a polysomnogram) is a test that records your physical state during various stages of sleep and wakefulness. It provides data that are essential in evaluating sleep and sleep-related complaints, such as identifying sleep stages, body position, blood oxygen levels, respiratory events, muscle tone, heart rate, amount of snoring and general sleep behavior.

Arriving at the sleep lab and initial paperwork:

If your physician feels you need a sleep study you will make an appointment for a test that will take place at night in the sleep center. After your arrive at the sleep center, you will be asked to complete questionnaires on your sleep the night before and a brief sleep history. Many sleep centers offer a video or other information about the sleep study or specific disorders such as sleep apnea, since a significant percentage of those who have sleep tests are suspected to have sleep apnea. The video may also address what you should expect during the sleep test to ease any concerns that you may have. Then you will be asked to change into nightclothes.

Applying electrodes:

After changing, the polysomnographic technologist will connect you to the electrodes that will record your brain waves and muscle movements throughout the night. This will not hurt or break the skin. The electrodes are placed in specific areas and applied with water-soluble gel and tape. The electrodes record brain waves, muscle movement, rapid eye movement (REM), air intake, and periodic limb movement. A microphone attached to your neck records snoring, and two belt-like straps around the chest and lower abdomen monitor muscle movement during breathing. Despite all of the equipment, most people say it doesn’t disrupt their sleep.

Testing electrodes and Monitoring:

After settling into bed, your technician may go to a monitoring room and ask you over an intercom to perform certain tasks that will show the electrodes are recording properly. You will be observed on a television monitor during the night, but that is to allow the technician to note your body movements during sleep.

Follow up:

A follow up appointment with your referring physician may occur after your initial sleep study. If your physician feels you have symptoms requiring a second night in the sleep lab; this may be scheduled prior to your follow up. During the follow up, the physician will discuss results, and may prescribe treatment for a sleep disorder.

List of things to do the day of your test:
• Do not drink alcohol or caffeine.
• Arrive on time, since setup takes some time.
• Bring a pair of comfortable bedclothes. Some patients like to bring their own pillows or blankets as well.
• Bring any medications you are being prescribed or will need to take during the hours you will be at the sleep center.
• Generally, you are asked to obtain a normal nights sleep the night before the test. Do not take naps on this day.

Sleep labs are beginning to take advantage of the added simplicity, patient comfort and cost savings associated with wireless technology. If a sleep lab is considering going wireless, it is important that they have each potential supplier in for an actual run through, and preferably allow a 30-day trial at their facility. Some wireless units, for instance Bluetooth devices, have a limited range and may not be suitable for labs with long hallways without added tools. Anyone who has ever lost a connection on a cell phone knows that wireless technology is not yet flawless. If a PSG study is interrupted several times through the night, typically since the amount of PSG data being transmitted is so large, even brief lapses can disrupt acquisition, annoy sleep techs and may affect data interpretation.

If your sleep lab is considering going wireless here’s an important list of questions you should ask potential wireless PSG equipment supplier:

1. What frequency range does the system operate in?
2. How far can the patient be from the monitoring room?
3. How many devices can we have working at one time without interference (cross-talk) risk?
4. What is the battery life of the device under continuous use? You need to make sure the device can stay on at least a full night. (Wireless technology can consume a lot of power).
5. What happens when there is interference – can the device retransmit data? Can it run a “spectrum sweep” of the environment?
6. How difficult is it to change the operating frequency to move away from the interference?

This post draws on the experience of several experts at CleveMed and is an adaptation from “Wireless Polysomnography” as seen in Sleep Diagnosis and Therapy, June⁄ July 2006.