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: 2.76). 12/2008; 14(6):525-9. DOI: 10.1097/MCP.0b013e328312ed4a
Source: PubMed


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.

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    • "These alternative devices are systems specialized for detection of certain sleep disorders (e.g. obstructive sleep apnea [8, 9]). On the other hand, a software for automatic sleep scoring (e.g. "
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    ABSTRACT: Purpose: Classically, professional assessment of sleep is done in the sleep laboratory using whole-night polysomnography (PSG). However, given a misbalance between accredited sleep laboratories and the large amount of patients suffering from sleep disorders, only few receive appropriate diagnostic assessment. Recently, some low-cost home sleep scoring systems have been proposed, yet such systems are rarely tested scientifically. The aim of the present study was to evaluate the staging accuracy of the home sleep scoring system Zeo (Newton, MA, USA). Methods: A final sample of 21 nights from ten subjects (aged 23-45) was digitally recorded with PSG as well as with the Zeo system. We compared scorings of Zeo (on an epoch-be-epoch basis) with the Somnolyzer 24 × 7 (an automatic staging algorithm), expert scorers as well as the freeware SleepExplorer. Results: It was revealed that Zeo shows moderate overall agreement as compared to our study standard Somnolyzer 24 × 7 (κ = 0.56). The most obvious performance difference between Zeo and both other scoring approaches was stage wake (sleep onset latency + wake after sleep onset). While Zeo detected only 40.8 % of the study standard wake epochs, 70.1 % were detected by the expert scorers and 83.4 % by the SleepExplorer, respectively. Conclusions: Data suggest that the Zeo system produces acceptable sleep scoring for stage REM, light and deep sleep, with a specific weakness in correctly detecting waking periods.
    Sleep And Breathing 09/2012; 17(2). DOI:10.1007/s11325-012-0757-4 · 2.48 Impact Factor
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    • "Several portable devices have been developed to record sleep parameters on an ambulatory basis. They are used for screening or for definitive OSA diagnosis, according to local policies (Collop, 2008; Portable full polysomnograph (Type 2; Standards of Practice Committee of the American Sleep Disorders Association., 1994) for unattended, homebased PSG is known to achieve an accurate record of sleep physiological data with a good signal quality (Iber et al., 2004; Kapur et al., 2000). "
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    ABSTRACT: To date, the clinical use of unattended home-based polysomnography (PSG) is not recommended. To assess whether sleep efficiency is better at home, we have performed a prospective, crossover, single-blind study comparing unattended home- versus attended in-hospital PSG in a population referred for high clinical suspicion of obstructive sleep apnoea syndrome (OSA). Within 2 weeks, all the patients underwent both PSG performed by the same sleep technician, which were analysed by another blinded technician. Payments for each procedure were also calculated. Sixty-six patients (mean age: 49±13 years; mean body mass index: 30±7; mean Epworth Sleepiness Scale: 10±5) were included. The quality of recordings was poor in 1.5% of the attended PSG versus 4.7% for unattended PSG (P=0.36). Sleep efficiency at home was better (82% versus 75%, P<0.001), and sleep duration longer (412 min versus 365 min, P<0.001). Sleep latency was also shorter at home (28 min versus 45 min, P=0.004), and patients spent more time in rapid eye movement sleep (19% versus 16%, P=0.006). Apnoea-hypopnoea index (23 versus 26, P=0.08) was similar at home and in the sleep lab. Sixty-seven per cent of patients preferred home-based PSG. PSG payment was also lower at home (268 Euros versus 1057 Euros). We conclude that home-based PSG is associated with a better sleep efficiency. It also appears as feasible and reliable in patients with high preclinical suspicion for OSA. It is also more comfortable for the patients whose sleep efficiency is better and allows cost saving related to the absence of hospitalization.
    Journal of Sleep Research 03/2011; 20(1 Pt 2):201-6. DOI:10.1111/j.1365-2869.2010.00859.x · 3.35 Impact Factor
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    ABSTRACT: Portable sleep apnea monitoring or home testing for sleep-disordered breathing focuses on recent developments of these powerful diagnostic tools. Evidence-based reviews and innovative single studies with specific systems are considered. Systems become less intrusive and self applicable. Electrocardiogram-derived respiration, photoplethysmogram analysis, midsagittal jaw movements, and respiratory sound analysis are reviewed. Categories of systems with 4 to 6 channels and 1 to 3 channels are introduced and presented. The importance of a high pretest probability is elucidated. Open research questions regarding these systems are mentioned. Technological issues are not most important in this debate. The health economic aspects in using portable sleep apnea monitoring have to be considered as well. Portable monitoring of sleep apnea is probably less expensive than cardiorespiratory polysomnography and can help to overcome the limited availability of sleep lab-based diagnostic places. But by increasing the quantity of investigations it may cause additional costs too.
    06/2012; 1(2). DOI:10.1007/s13665-012-0014-0
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