Wednesday, January 09, 2008

Resmed Consultant Behind Home Testing Movement

Sleep Well and Live has an interesting post today about the movement for home osa testing and its originator:
At the 2004 Annual Meeting of the American Academy of Otolaryngology - Head and Neck Surgery Foundation in New York, Terence Davidson, an Otolaryngologist (ENT) and Dean of Continuing Education at the University of California, San Diego, was invited to give a “mini seminar” entitled “Thinking of Opening a Sleep Lab?” Dr. Davidson could also be called the “father” of the current attempt to get Medicare to approve unattended home testing for sleep apnea. It was his Jan. 29, 2004 letter to the Centers for Medicare and Medicaid Services (CMS) that argued that the current policy is inhibiting the diagnosis of obstructive sleep apnea (OSA) because the nation’s 692 sleep labs are simply too full.

During Dr. Davidson’s presentation in New York, he had some interesting opinions and comments and also seemed to have some conflicts of interest and an astounding degree of arrogance towards the Sleep Medicine and Pulmonary Medicine professions.
Although he has claimed to have no conflicts of interest, Dr. Davidson is on the Medical Advisory Board of Directors of ResMed, Inc. as a paid consultant. ResMed and their auto titration CPAP units stand to benefit substantially from gaining Medicare’s approval of in-home, unattended testing.

As to Dr. Davidson’s assertion that the current policy for our Medicare population is inhibiting the diagnosis of OSA because the nation’s sleep labs are simply too full, recent data from the American Academy of Sleep Medicine states that the availability of sleep laboratories across the United States based on a 2001 study of 2001 data estimates that 427 PSG were performed per year per 100,000 population. (5) Since 2001, the number of sleep laboratories accredited by the AASM has more than doubled to 1,169, with 129 applications having been received in just the first three months of 2007, alone.
In a 2004 AASM survey, there was an average wait of about three weeks for a sleep study or sleep consultation. An independent survey in 2004 by Shariq estimated there were more than 2,500 accredited and non-accredited sleep laboratories in the US with an average wait time for a PSG between two and three weeks.

I encourage you to read the full post.


LaRPSGT said...

I have followed your last two blogs without comment. I cant stay quiet any longer. As a RPSGT, a person that has spent hours with the patient, attempting to make them feel comfortable, and at home. I have heard the stories about their grandchildren, current drug use, stresses in their lives or just the things that make them happy. We sleep techs tend to receive much more patient information, that they have not had the opportunity to disclose in a short doctor's visit. Then as the PSG begins, and problems arise many of which are'nt just OSA. Alpha intrusion, PLMs, RLS, Seizures,undiagnosed heart arrhythmias that seem to only appear in REM, along with countless other health risk that a home test would not pick up. Arousals are not limited to being caused by OSA. Not to mention the countless low scores on epworth and Berlin scales Ive seen, from patient's with severe OSA! Not all patient's have the same perception of how "tired" feels. How can any health professional say home test are in the best interest of the patient? It's all about cutting corners and saving dollars. It all saddens me greatly. At a time when I was becoming so excited that more physicians and patients are becoming more educated of the effects of sleep disorder on overall health. I am worried about those patients that a sleep tech. like me, will not get the chance to know.

Michael Rack, MD said...

I agree with you. Thanks for posting

Steve Gardner said...

Dr. Rack: I'd like to make an update on our original blog post on home testing. Dr. Davidson is no longer on ResMed's medical advisor board, which was dissolved in 2006. He was, however, a member of the board from 2004 to 2006.

Thank you.
Steve Gardner
Sleep Wellness Institute

Sovann Pen said...


Well said!
I cringe when I hear about patients having UARS/OSA ruled out based on overnight oximetry or being titrated (first time) on an autoPAP.

On the other hand it's frustrating when patients have to wait 3-4 months for a PSG.

Lorre said...

It would be nice if this would provide access to testing for those who currently cannot afford it or have no medical insurance. With the seriousness of sleep apnea it seems that this is better than no testing at all.My grown son has no medical insurance and I worry about him all the time because of what I hear when he's sleeping-snoring-and not breathing. He has a very large neck (offensive lineman) and I would be happy for now to just to get a CPAP mask put on his face!!!!