PURPOSE: Significant limitations to portable monitoring for diagnosis of sleep disorders raise concerns about widespread use of this diagnostic modality. A protocol-based algorithm with a safety-net addresses these concerns. This study presents initial data on outcomes and patient satisfaction of a protocol-based algorithm.
METHODS: We established a comprehensive system of patient evaluation including protocols which assist a polysomnographer in directing patients to different arms of the algorithm. Prescreening would determine patients ineligible for portable monitoring based upon 10 predetermined exclusionary criteria. Excluded patients would be directed to other arms of the algorithm including formal polysomnography in a sleep lab. A PAT (peripheral arterial tonometry) based device was used for portable monitoring. For patients in the portable monitoring arm, additional algorithms were established based upon results of testing. Finally, a clinical response to treatment algorithm was used after initiation of auto-titrating CPAP to redirect patients to the sleep lab if suboptimal response was noted. Patient satisfaction was evaluated and a quantitative assessment of compliance and success was scored.
RESULTS: A high degree of patient satisfaction was noted. Very few device failures were noted. Amongst patients completing the portable monitoring, 22% required referral for formal polysomnography. Additionally, clinical follow-up evaluations of patient response to auto-CPAP yielded high continued patient satisfaction. Post auto-CPAP "safety-net" evaluations resulted in 18% of patients being referred for polysomnography.
CONCLUSION: A portable sleep monitoring program can be effectively managed with high patient satisfaction and quality patient care using a protocal-based system which includes a "safety-net" back up plan for selected patients.
CLINICAL IMPLICATIONS: Portable sleep monitoring has advantages in cost, convenience and patient satisfaction. Limitations of this form of testing can be addressed in a satisfactory manner in a protocol based algorithm and a safety-net algorithm. This program can contribute significantly to addressing the large volume of undertreated patients with sleep apnea while at the same time containing costs.
DISCLOSURE: Richard Tejedor, No Financial Disclosure Information; No Product/Research Disclosure Information