Chest
Recent Advances in Chest MedicinePortable Monitoring for the Diagnosis of OSA
Section snippets
Outpatient Validation
A number of studies have found home diagnosis and treatment algorithms for OSA to be noninferior to traditional attended, in-laboratory PSG followed by in-laboratory PAP titration studies. In a 2011 randomized, noninferiority trial conducted at two Veterans Administration (VA) sleep centers, 296 patients were randomized to undergo either traditional in-laboratory PSG followed by in-laboratory CPAP titration or a home portable study followed by in-home autotitrating positive airway pressure
Inpatient Applications
Sleep-related symptoms, ranging from insomnia to excessive daytime sleepiness, are a common and underappreciated problem in hospitalized patients.32 Up to 39.5% of patients aged > 50 years hospitalized on a general medical ward are at high risk of SDB, although the prevalence may be as high as 50%.33, 34 Among inpatients in whom the suspicion for SDB is high enough to merit referral for inpatient PSG, the prevalence of SDB is as high as 77%.35
The high prevalence of SDB in the inpatient setting
Conclusions
Portable monitors have become an important tool in the armamentarium used to manage SDB. In the outpatient setting, portable monitors and home testing algorithms have been found to be noninferior to laboratory-based diagnosis of OSA and titration of PAP therapy. Several studies now suggest that even primary care-based portable monitoring algorithms may be equivalent to sleep center-based management, assuming that providers have experience in clinical sleep medicine and that there is sufficient
Acknowledgments
Financial/nonfinancial disclosures: J. S. B. has received speaking fees from Itamar, Inc. None declared (J. A. C.).
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