Medical Evidence of High Res Data...a physician perspective

[Loggerhead]

I'm a board certified primary care physician, but not a board certified sleep physician. I review high res data multiple times each day in ResScan for my patients (man, that software sucks compared to OSCAR, but IT guys doesn't like OSCAR). I manage a LOT of PAP therapy, well over 500 patients in my own personal practice.  This comes as a result of an enormous shortage of sleep specialists...we are the de facto "specialists".  The issue I run into is that, as a primary care physician who isn't board certified in sleep medicine, I feel an obligation to refer my patients that have significant CSR or CSA to Pulm/Sleep Medicine.  My consultant physicians aren't very supportive of reviewing high res data.  My patients with CSR/CSA are coming back to me to take over management, because the consultant won't review high res data, saying it isn't accurate or it is flawed.  Today I got a phone call encouraging me not to review high res data and just rely upon an in-lab titration study if patients aren't doing well.

So, my question is, are there physicians on here that have links to clinical guidelines or peer reviewed articles discussing office based review of high res data?  

It makes a ton of sense to me to use high res data; I don't admit my patients to the hospital every night I feel like I need to change their blood pressure medication...I review flawed blood pressure logs and use that data.  Same thing here with PAP therapy.


In medicine we don't rely upon anecdotes, we rely upon good quality studies to change practice.  I performed a cursory lit review on pubmed and didn't find a study evaluating outcomes of office based titrations (via data download) vs in lab titrations.  Maybe I'm not searching the right terms or methodology.

[akarifur]

Hi there. First of all I am NOT a physician or medical expert at all. But I wanted to respond and say thank you for caring about your patients to the degree of looking at the high res data. There are alot of physicians who won't even try or go that far. To be honest with you, from my experience with the sleep center I was referred to, you are probably more qualified than my sleep "doctor" was. First of all my sleep "doctor" misrepresented herself as a doctor, or even as a board certified sleep specialist (she was not at all). Her only actual accreditation was paying 100 bucks a month for a sleep medicine journal. However, there literally is no better option in my area. For me I had to take ownership over my own data and learning to look at it. Though I did pay Jason at (axgsleepdiagnostics.com) for a consultation. He is a registered sleep technician so maybe reaching out to him would be helpful for you? Anyway one thing to be aware of is to try and give support to your patients even when the sleep doctors play cagey. For me Jason and this community was able to identify i needed to switch from CPAP to Bilevel. However my sleep "doctor" refused to prescribe it or even consider it unless i went through a battery of her tests inlab, despite me having weeks of hires data i could show her and (she could view herself). When I refused to do the in lab study she basically threatened to cancel my referral to her, to which i found a way to find someone else (legitimate don't worry) to do my prescription so she ended up having no power over me.

Point is the sleep medicine space is a trash fire, and IMO you just by being willing to look at the data have magically become more qualified then probably most of the sleep medicine doctors. (Especially in my area.)

Disclaimer: This was in no way meant to be an insult to sleep technicians and sleep doctors who actually take an ownership and interest in patients, the sad reality is that you are few and far between and i think most people on this forum if we knew were one of them would line up at your practice so be careful