An official ATS/AASM/ACCP/ERS workshop report: Research priorities in ambulatory management of adults with obstructive sleep apnea.

Proceedings of the American Thoracic Society 03/2011; 8(1):1-16. DOI: 10.1513/pats.2009-042WS
Source: PubMed

ABSTRACT An international workshop was held to determine the research priorities for incorporating ambulatory management of adults with obstructive sleep apnea into healthcare systems. The workshop identified the barriers preventing incorporation of portable monitor testing into clinical management pathways and determined the research and development needed to address those barriers. The workshop promoted interaction and collaboration among diverse stakeholders who have interest and expertise in the development and evaluation of portable monitor technology and its clinical application. The consensus of the workshop participants was that outcomes-based research studies are needed to demonstrate the efficacy and cost effectiveness of portable monitor testing. Closely related to this objective is the need to develop clinical sleep research networks capable of performing adequately powered studies. Recommendations were developed regarding research study design and methodology that includes the need to standardize technology, identify the patients most appropriate for ambulatory management of obstructive sleep apnea, ensure patient safety, and identify sources of research funding. The evidence resulting from high-quality comparative effectiveness studies that include cost effectiveness as an outcome will allow decision makers to develop healthcare policies regarding the clinical application of portable monitor testing for the ambulatory management of patients with obstructive sleep apnea.

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    ABSTRACT: Restorative sleep is an important factor for well-being, performance and quality of life. The basic diagnostic procedure of a sleep disorder is to take a comprehensive sleep history. Sleep disorders can and must be distinguished from the physiological changes of sleep in the elderly. Insomnia (difficulty in sleeping), daytime sleepiness (hypersomnia), sleep-related breathing disorders (SRBD) and movement disorders during sleep are also common in the elderly. They must be detected because they are treatable and can dominate the clinical picture of geriatric syndromes. Nursing home residents and dementia patients are in particular need of attention as their sleep is often adversely affected by the living environment and the daily institutional routine.
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    ABSTRACT: Objectives: Obstructive sleep apnea (OSA) may contribute to impaired performance among otherwise healthy active duty military personnel. We used decision analysis to evaluate three approaches to identifying and treating OSA in low-risk populations, which may differ from current standard practice for high-risk populations. Methods: We developed a decision tree to compare two simple strategies for diagnosis and management of sleep apnea in a low-risk population. In one strategy, a simple screening inventory was followed by conventional laboratory polysomnography (split-night), whereas the alternative strategy involved performing home testing in all individuals. This allowed us to weigh the costs associated with large-scale diagnostic approaches against the costs of untreated OSA in a small fraction of the population. Results: We found that the home testing approach was less expensive than the screen-then-test approach across a broad range of other important parameters, including the annual performance cost associated with untreated OSA, the prevalence of OSA, and the duration of active duty. Conclusions: Assuming even modest annual performance costs associated with untreated OSA, a population strategy involving large-scale home testing is less expensive than a screening inventory approach. These results may inform either targeted or large-scale investigation of undiagnosed OSA in low-risk populations such as active duty military.
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