Saturday, November 17, 2007

Auto-CPAP in the new portable testing world

To paraphrase a reader question, what role will auto-CPAP play in the future?

Auto-CPAP is basically CPAP that is self-adjusting based on the patient's pressure needs (various manufacturers have different alogorithms to monitor airlow). There are 3 main ways to use auto-CPAP:

1. Some patients who undergoe an in-lab regular CPAP titration are found to have large pressure difference needs between different body positions or sleep stages. In these cases, the patient can be prescribed auto-CPAP within a preset pressure range. For example, if someone needs a pressure of 6 during stage 2 sleep and 10 during REM, he might be prescribed an auto-CPAP machine that was set to automatically adjust between 6 and 10.

2. A patient could just skip the in-lab titration and be sent home with an auto-cpap machine for permanent use. The pressure range might initially be set at 4-20 and then gradually narrowed based on the data generated by the auto-cpap machine.

3. Instead of an in-lab titration, a patient could be loaned an auto-cpap machine for a few days to use at home. Based on the data generated by the machine, the patient could be prescribed a regular fixed pressure cpap machine.

Most sleep specialists, including myself, do option 1 at times. Some sleep specialists will do options 2 and 3 occasionally, but this requires close patient follow up and in my opinion is not appropriate for widespread use, nor for use by non-specialists. If options 2 and 3 become more widespread it would reduce the number of titration studies done by sleep labs and have a negative financial impact on the sleep testing industry.
Edit (11/21)

A reader asked about reimbursement for options 2 and 3:

I am not directly involved in the DME business, so I don't know exactly what the profit margin is on cpap and auto-cpap machines. For option #2, the physician would collect standard office visit fees and the DME company would sell the patient an auto-cpap machine. Currently, most insurance companies reimburse auto cpap machines (for permanent home use) at the same amount as a standard cpap machine. I have been told by DME companies that they lose money every time they do this.
For option #3, usually the patient (at least in my area) is not charged for borrowing the auto-cpap machine (from the DME company) for a few days for an at-home auto-cpap titration. The DME makes its money by then selling the patient a regular cpap machine. The physician charges standard office visit codes.


john maxo said...

Auto pap is more effective in comparison to cpap.Very much thanks for increasing my knowledge about auto pap.Really thanks for sharing this effective blog...

james thomos said...

I found bipap uncomfortable and useless for my central sleep apnea. Straight CPAP was also useless. My understanding is these machines (if without ST backup) are designed only for obstructive sleep apnea.
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