Portable monitoring for the diagnosis of obstructive sleep apnea.

Division of Pulmonary/Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
Current opinion in pulmonary medicine (Impact Factor: 2.96). 12/2008; 14(6):525-9. DOI: 10.1097/MCP.0b013e328312ed4a
Source: PubMed

ABSTRACT The demand for expedient diagnosis of suspected obstructive sleep apnea (OSA) has increased due to improved awareness of sleep disorders. Polysomnography (PSG) is the current preferred diagnostic modality but is relatively inconvenient, expensive and inefficient. Portable monitoring has been developed and is widely used in countries outside the United States as an alternative approach. A portable monitor records fewer physiologic variables but is typically unattended and can be performed in the home.
Numerous portable monitor studies have been performed over the past two to three decades. The US government and medical societies have extensively reviewed this literature several times in an attempt to determine if portable monitoring should be more broadly used for diagnosing OSA. In March 2008, the US Centers for Medicare and Medicaid Services released a statement allowing the use of portable monitoring to diagnose OSA and prescribe continuous positive airway pressure. This has potentially opened the door for more widespread use of these devices. This review will focus on the literature that has examined portable monitoring as a diagnostic tool for OSA.
It is anticipated that portable monitoring as a diagnostic modality for OSA will be used more frequently in the United States following the Centers for Medicare and Medicaid Services ruling. Physicians and others considering the use of portable monitors should thoroughly understand the advantages and limitations of this technology.

  • [Show abstract] [Hide abstract]
    ABSTRACT: Recently, portable sleep recording devices became an accepted alternative to polysomnography (PSG) for obstructive sleep apnoea (OSA) diagnosis in patients with a high pre-test probability of moderate to severe OSA but home polysomnography (H-PSG) was not recommended because there was insufficient data. The present review has analysed six prospective randomiszed cross-over studies comparing H-PSG to in-lab PSG. These studies convincingly showed that H-PSG allows complete sleep evaluation. The quality of patient's sleep tends to be better at home. H-PSG is accurate for OSA diagnosis and the failure rate is low despite the absence of supervision. In addition, it could offer a final and comprehensive diagnosis for many other sleep disorders. It is also likely that H-PSG can reduce PSG-related costs but complete cost-effectiveness analyses are not yet available. Recently, remotely attended H-PSG via telemonitoring has been tested and may reduce H-PSG failure rate. In conclusion, H-PSG can be used to rule-in and rule out OSA in suspected patients, even in the presence of co-morbidities and is an alternative when type 3 recording is negative. Future developments should target simplification of technical aspects of H-PSG, together with remote monitoring, in order to obtain good quality H-PSG performed in adequate conditions.
    Sleep Medicine Reviews 01/2013; DOI:10.1016/j.smrv.2013.12.002 · 9.14 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Due to increasing demand for sleep services, there has been growing interest in ambulatory models of care for patients with obstructive sleep apnea (OSA). The implementation of alternative approaches to the current management by full polysomnography (PSG) in the sleep laboratory is necessary for diagnosing this syndrome due to the high cost of full-night PSG. A good alternative option for OSA diagnosis is portable monitoring (PM), which is known for its accuracy, ease of management and lower cost when compared with full PSG. PM has not been well validated for OSA diagnosis in patients with medical comorbidities or in elderly individuals and children. PM may be recommended as an alternative method to PSG for patients with high clinical risk for OSA. In the present review, we describe the use of PM for OSA diagnosis and evaluate the current progress, costs, limitations and applications of these devices in various groups of patients, particularly for patients with comorbid diseases.
    Expert Review of Respiratory Medicine 12/2013; DOI:10.1586/17476348.2014.850421
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: A Technology Assessment INTRODUCTION The California Technology Assessment Forum (CTAF) has been asked to update its review of the scientific literature on the safety and efficacy of portable devices used in the home to diagnose patients with obstructive sleep apnea. Home diagnostic devices for sleep apnea were last reviewed by the Forum in June 2005. 1 At that time, the recommendation of the systematic review was that portable devices did not meet CTAF criteria. Since that time, several new studies and reviews have been published and the Centers for Medicare and Medicaid Services (CMS) issued a national coverage decision supporting the coverage of continuous positive airway pressure (CPAP) based on home diagnosis of sleep apnea using portable devices. An updated review was considered in October 2008, but was tabled.