Obstructive sleep apnea (OSA) is a highly prevalent disease with estimates that 20% of white men and women with body mass index between 25 and 28 kg/m2 have an apnea-hypopnea index (AHI) of ≥ 5.1–
In recent years, OSA has been associated with a number of common morbid conditions, including heart disease, stroke, diabetes, and motor vehicle accidents. These links and the fact that the disease is readily treatable with nasal continuous positive airway pressure (CPAP) have accelerated the need for prompt and accurate diagnosis. The current standard clinical workup includes a history, a physical examination, and a referral to a sleep disorders laboratory for an overnight complete polysomnogram. If OSA is found, a second overnight polysomnogram with nasal CPAP is performed. Given the length of time, the costs and technical expertise required, along with the advances in computer technology, a move toward less complicated techniques in the home has gained popularity. In a recent issue of CHEST, an extensive evidence-based review of the current status of portable monitoring for the diagnosis of OSA was published.2
A subsequent publication in Sleep used this evidence review to develop clinical practice guidelines.3
The outcome of these articles suggests that portable monitoring for the diagnosis of OSA is not quite “ready for primetime.” The evidence review was based on 49 articles in the peer-reviewed literature. The authors of the evidence review systematically evaluated each article with the help of an evidence practice center to determine its quality. The evidence was used to generate a practice parameter, which states that unattended portable monitoring devices (specifically level III devices, recording typically 4 to 7 parameters, and level IV devices, recording one or two parameters) should not be used routinely in clinical practice. Many would argue that the question regarding limited portable studies would have been better addressed with a consensus conference rather than a literature-based review; however, given the extreme complexity of this problem, the sponsoring organizations agreed that this was the most appropriate approach. The article by Liesching et al in this month’s issue of CHEST (see page 886) points out many of the hazards of using portable monitoring without appropriate scientific validation.