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Editor’s Message: Parallel Universes

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When it comes to charting territory in the brave new world of HST, you may find help in the playbook of a different industry.
By Sree Roy

Like many of you, I glean insights from parallel sets of circumstances. A breakthrough with one patient could mean a similar tactic will solve another’s medication challenge, or a colleague’s research abstract may trigger an analogous study in a different specialty. But unlike many of you, my background is most recently in the beauty industry—I say “most recently” because I’ve covered a myriad of fields over the years—and one parallel to sleep medicine has captivated me during my first month at Sleep Review.

In the professional beauty realm, many salon owners bite their neatly manicured nails in worry when they spy a bottle of no-chip polish at their local drugstore; they fear that if a customer procures the tools to fix her nails at home, she’ll no longer need professional services. Meanwhile, as you are well aware, the professional sleep medicine industry struggles with the uncertainty about the changes home sleep testing (HST) will usher in. The elephant in the room is whether HST will render irrelevant some aspects of the profession.

But here’s the insightful correlation: The corner nail salon isn’t going anywhere…and neither are adaptive sleep professionals. One study found that women who use DIY nail care products the most are the same population who frequent the nail salon the most often. While the sleep medicine issue is more complex, including such variables as insurance reimbursements, my advice to salon owners is the same as what I offer to you: If you can’t beat ’em, join ’em. Just as salons should shore up their retail shelves with DIY nail care equipment, sleep labs and doctors should find ways to incorporate HST into their own strategies.

Edward D. Michaelson, MD, says the “incorporation of HST into existing sleep diagnostic facilities may be a viable option for certain sleep labs.” He adds the key to offering HST at a profit will depend on the implementation. You’ll have to make cost-effective choices on such variables as type of HST equipment, data security access storage, auto versus hand scoring, and the physician’s interpretation fee, he advises.

There are a number of HST users who’ll eventually need facility-based studies, Michaelson adds. HST can serve as a starting point to an evaluation by a sleep medicine specialist, such as when the OSA severity warrants an attended in-lab polysomnogram. Plus, if CPAP therapy fails to improve symptoms, that’s another opportunity for the sleep lab or sleep physician to step in. “The stronger sleep labs, particularly those with associated integrated programs and good relationships with their referring physicians, are in a better position to weather the HST storm,” Michaelson says.

But, to me, the biggest benefit to HST isn’t all of these exciting adaptations that accompany change—rather, the greatest advantage is the increased awareness of sleep disorders in the general population. With an estimated 85% of OSA sufferers currently undiagnosed, the increased access, convenience, and affordability of HST may well translate into more people finding relief. And if we find a way to act on HST results to the professional sleep industry’s advantage and maximize the efficient use of sleep testing facilities, well, that’s just good medicine, whether it starts at home or in the lab.

– Sree Roy, sroy@nullallied360.com