Chest
Volume 149, Issue 4, April 2016, Pages 1074-1081
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Recent Advances in Chest Medicine
Portable Monitoring for the Diagnosis of OSA

https://doi.org/10.1378/chest.15-1076Get rights and content

In-laboratory, attended polysomnography has long been the gold standard for the diagnosis of sleep-disordered breathing (SDB). In recent years, economic pressures and long wait times have driven interest in home sleep testing, which has, in turn, led to the development of algorithms that bypass the sleep laboratory in favor of portable monitoring studies and in-home initiation of positive airway pressure therapy. For appropriately selected outpatients, evidence is accumulating that portable monitors are a reasonable substitute for in-laboratory polysomnography. In the inpatient setting, in which SDB is both highly prevalent and associated with adverse outcomes in certain populations, the literature is evolving on the use of portable monitors to expedite diagnosis and treatment of SDB. This review discusses society guidelines and recent research in the growing field of portable monitoring.

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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