Is facility-based titration study necessary for physician to order ASV device?

[DevinJones]

Can a sleep apnea physician in the U.S. legally prescribe an ASV device for a patient who has not had an in-lab, attended titration study?

The physician has the results of the patient's home sleep study and a week's worth of data from the patient's use of an APAP device.

[Gideon]

Anyone that can write a prescription can write a prescription for an ASV.
The question should be
Is a Dr. writes a prescription will my insurance pay for it?

An ASV is among the most expensive of the PAP machines. Most insurance companies want the doctor to prove that cheaper alternatives do not work thus lessening the cost. An ASV titration study is often used to prove the efficacy of the ASV thus proving that it does work.

Because ASV machines are so good at what they do, especially the ResMed ASV, that the can nearly eliminate all apnea with the default settings. Thus they don't need titration. The ResMed ASV samples your breathing then calculates a average minute vent over the last 90 seconds and adjusts PS to maintain that volume. Note that if pressure variations are di_icult for you to manage this is likely not the machine for you.any users achieve a near zero AHI with this machine.

[DevinJones]

Thanks for explaining the effectiveness of the ASV devices.

I'm still interested in knowing the answer independent of the insurance coverage issues.

For example, can a physician legally prescribe an ASV device that the patient will pay for privately with cash when the patient has not had an attended titration study?

Is it legal and within the medical standard of care for a sleep doctor who will use the ResMed ASV data to titrate or adjust the ASV settings remotely?

[fly by night]

Anyone that can write a prescription can write a prescription for an ASV.

Your question has been answered.

[Gideon]

Ethically a prescriber should only write prescriptions for those patients that would benefit from. There are conditions that an ASV is inappropriate for, specifically those medical conditions that cause a diminishing volume over night. These require a device that has a fixed volume target.

But as I said before any doctor can prescribe with or without a test (titration). He should have evidence that the solution is a good one. But he IS capable of writing a prescription.

[DevinJones]

Thanks very much, Gideon. for clarifying for me.