Home Sleep Studies
To give physicians another diagnostic tool, home sleep studies (Type III) are now available through North Kansas City Hospital. Not every patient who has symptoms indicative of possible sleep apnea requires attended polysomnography defined as a Type 1/2 sleep study in the outpatient Sleep Health Center. The less intrusive (and more cost effective) in-home studies can give you the answers you’re looking for.
Type III - Home Sleep Testing
Home Sleep Testing from North Kanas City Hospital’s Sleep Health Center offers the highest level of direct patient education about the test equipment and the testing procedure. When patients pick up their testing equipment – which is about the size of a smart phone and twice as thick – they receive personal instruction about how to use it and general education on sleep apnea. This education helps motivate patients to perform the study to the best of their ability. North Kansas City Hospital claims the lowest home study failure rates in the city.
No One Should Snore
Pulmonologist James Ladesich says, “No one should snore. Sleep apnea is the most unappreciated malady in medicine.” Dr. Ladesich with Meritas Health Pulmonary Medicine (formerly Pulmonary Medicine Associates) became intensely interested in sleep apnea and its comorbidities while completing his residency. He witnessed heart transplant patients who, when diagnosed with sleep apnea and properly treated, had radically improved heart function, allowing them to be removed from the transplant waiting list. Sleep apnea left untreated leads to elevated hormones that affect blood pressure, heart failure management, and diabetes management to name a few commonly seen comorbid conditions.
Dr. Ladesich says, “Sleep Apnea is the number one cause of high blood pressure.” Positively diagnosing and treating sleep apnea corrects or avoids many conditions, including CHF, cardiovascular disease, high blood pressure, AFib, stroke and heart attack. It also reduces readmissions for COPD and CHF patients.
The accredited sleep study program at North Kansas City Hospital features staff and physicians with over 20 years of experience and turnkey assistance. They interpret the data and they know the CPAP equipment. With hundreds of different masks and multiple modes available, a specialist can manage equipment details for you. Dr. Ladesich’s office offers patient visits with a skilled sleep technologist or respiratory therapist for follow up visits and to work with CPAP compliance issues, including mask fitting, equipment use and other sleep issues related to treatment.
Sleep studies are a reasonable approach to diagnosing your patients with sleep disorders. The patient who presents as tired or lazy may indeed have an undiagnosed, debilitating condition including:
- Sleep apnea
- Nocturnal seizures
- Hypoventilation syndrome
- Central sleep apnea
- Sleep related movement disorders
Outpatient Sleep Center Attended Studies
Attended sleep studies at North Kansas City Hospital include multiple Type I studies. Type I is the most comprehensive and includes individual monitoring of EEG, EKG, respiratory parameters and more, by a technologist. (Flexible schedules allow patients who perform shift work to easily complete this test.) Some conditions dictate a patient complete a Type I study. These conditions include morbid obesity, CHV, stroke and COPD.
Attended Sleep Studies: What Patients Can Expect
A private, one-to-one, sleep pre-study visit (45-60 minutes) puts patients at ease. They learn what is going to take place, what they need to bring, and what they should expect for the entire process. A pre-study visit is usually the first opportunity the patient has to fully understand what the study is, how it works, why they are doing it and how it will impact/improve their life. The pre-study visit results in fewer patients refusing to complete the sleep study after they arrive. While other labs report having weekly patient refusals at the time of the study, our Sleep Health Center reports one to two refusals per year. A pre-study visit is strongly encouraged and gives patients the opportunity to have the best study possible.
Type I Studies Offered
- Polysomnogram Only Sleep Study is a diagnostic study without intervention. CPAP will be initiated under Emergency Guidelines, per protocol.
- Split-Night Polysomnogram with CPAP/Bi-level titration as indicated. Includes documentation of sleep-related disordered breathing followed by the initiation and titration of CPAP/Bi-level therapy, if sufficient time to implement and titrate therapy is available, as per protocol.
- CPAP/Bi-Level Titration or Check/Titration Polysomnogram. CPAP/Bi-level will be initiated at the start of the study and titrated as protocol dictates. For an initial titration, a previous diagnostic polysomnogram should have been performed within the previous 3 months.
- Post-Op Polysomnogram. This study assesses the benefits from upper airway surgery. If disordered breathing persists, CPAP/Bi-level therapy will be initiated as per protocol.
- Multiple Sleep Latency Test (MSLT) determines daytime sleepiness in relationship to sleep disorders, especially narcolepsy. The MSLT must follow a diagnostic polysomnogram. The MSLT will be canceled if the diagnostic study demonstrates an untreated sleep disorder.
- Maintenance of Wakefulness Test (MWT) assesses alertness/wakefulness either following therapeutic intervention or complaint of sleepiness. Required most often by Department of Transportation (DOT), Federal Aviation Administration (FAA) or Railroad industry. No repeat polysomnogram necessary.
Type II studies involve a “ward” setting with one tech monitoring multiple patients. The Hospital doesn’t offer this type of study.
Type III studies are the newer unattended at-home studies. They include measuring breathing effort, air flow, oxygen saturation and pulse rate/heart rate.
Type IV are rarely performed and include pulse oximetry and additional parameters.
Home Sleep Testing
Type III studies are designed to confirm a high suspicion: The report will either present a confirmation with a high positive prediction or a low prediction, or negative, result for sleep apnea. Type III studies are not a screening tool. They have a high positive predictive value but low negative predictive value. A negative test should does not rule out sleep apnea if clinical suspicion is high. While physician compensation remains constant across all test types, patients realize significant cost savings with Type III and many insurance carriers require completion of Type III before authorizing Type I. Because an in-home study is less intrusive, patients are more likely to complete the test.
James Ladesich, MD
Dr. Ladesich earned his MD from the University of Kansas School of Medicine. He completed his residency in Internal Medicine and fellowships in Pulmonary, Critical Care and Sleep at University of Missouri - Kansas City. He joined Meritas Health Pulmonary Medicine in 2012. Dr. Ladesich is one of the few sleep specialists in the Northland.
To learn more call, (816) 474-3700.