ABSTRACT
Portable monitors are classified into three levels (Level II, III, and IV) with decreasing
measurements of sleep and respiratory variables. A full overnight sleep study with
respiratory measurements and sleep staging (polysomnography) unattended by a sleep
technician is Level II, three or more respiratory channels and heart rate generally
without sleep staging either attended or unattended is Level III, and one or two channels
attended or unattended, usually including oximetry, is Level IV. To date, some Level
III portable monitors appear to have sufficient specificity to diagnose the obstructive
sleep apnea (OSA) syndrome but are not sufficiently sensitive to exclude OSA. Attended
portable monitoring appears to provide better sensitivity and specificity than unattended
portable monitoring and is an option for diagnosis of OSA. The role of portable monitoring
is evolving but at this time cannot substitute for attended polysomnography as a standalone
approach. The exact place of portable monitoring and the cost-benefit depends on local
circumstances and cannot be generalized at this time.
KEYWORDS
Obstructive sleep apnea - portable monitoring - polysomnography
REFERENCES
- 1 Bassiri A G, Guilleminault C. Clinical features and evaulation of obstrutive sleep
apnea-hypopnea syndrome. In: MH Kryger T, Roth, WC Dement Principles and Practice
of Sleep Medicine. 3rd ed Philadelphia; WB Saunders 2000: 869-878
- 2 American Sleep Disorders Association .International Classification of Sleep Disorders,
Revised: Diagnostic and Coding Manual. Rochester MN; American Sleep Disorders Association
1997
- 3
Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S.
The occurrence of sleep-disordered breathing among middle-aged adults.
N Engl J Med.
1993;
328
1230-1235
- 4
Findley L J, Unverzagt M E, Suratt P M.
Automobile accidents involving patients with obstructive sleep apnea.
Am Rev Respir Dis.
1988;
138
337-340
- 5
Peppard P E, Young T, Palta M, Skatrud J.
Prospective study of the association between sleep-disordered breathing and hypertension.
N Engl J Med.
2000;
342
1378-1384
- 6
Hung J, Whitford E G, Parsons R W, Hillman D R.
Association of sleep apnoea with myocardial infarction in men.
Lancet.
1990;
336
261-264
- 7
Dyken M E, Somers V K, Yamada T, Ren Z Y, Zimmerman M B.
Investigating the relationship between stroke and obstructive sleep apnea.
Stroke.
1996;
27
401-407
- 8
Resta O, Foschino-Barbaro M P, Legari G et al..
Sleep-related breathing disorders, loud snoring and excessive daytime sleepiness in
obese subjects.
Int J Obes Relat Metab Disord.
2001;
25
669-675
- 9
Hening W, Allen R, Earley C, Kushida C, Picchietti D, Silber M.
The treatment of restless legs syndrome and periodic limb movement disorder. An American
Academy of Sleep Medicine Review.
Sleep.
1999;
22
970-999
- 10
Chervin R D, Murman D L, Malow B A, Totten V.
Cost-utility of three approaches to the diagnosis of sleep apnea: polysomnography,
home testing, and empirical therapy.
Ann Intern Med.
1999;
130
496-505
- 11
Ferber R, Millman R, Coppola M et al..
Portable recording in the assessment of obstructive sleep apnea.
Sleep.
1994;
17
378-392
- 12
Standards of Practice Committee of the American Sleep Disorders Association .
Practice parameters for the use of portable recording in the assessment of obstructive
sleep apnea.
Sleep.
1994;
17
372-377
- 13
Flemons W W, Littner M R, Rowley J A et al..
Home diagnosis of sleep apnea: a systematic review of the literature: an evidence
review cosponsored by the American Academy of Sleep Medicine, the American College
of Chest Physicians, and the American Thoracic Society.
Chest.
2003;
124
1543-1579
- 14
Le Bon O, Hoffmann G, Tecco J et al..
Mild to moderate sleep respiratory events: one negative night may not be enough.
Chest.
2000;
118
353-359
- 15
Reichert J A, Bloch D A, Cundiff E, Votteri B A.
Comparison of the NovaSom QSG, a new sleep apnea home-diagnostic system, and polysomnography.
Sleep Med.
2003;
213-218
- 16
Anonymous.
Sleep-related breathing disorders in adults: recommendations for syndrome definition
and measurement techniques in clinical research. The Report of an American Academy
of Sleep Medicine Task Force.
Sleep.
1999;
22
667-689
- 17 Available at: http://www.aptweb.org/pdf/cmscpap.pdf. Accessed December 13, 2003.
Medicare CPAP Criteria
- 18
Flemons W, Littner M R.
Measuring agreement between diagnostic devices.
Chest.
2003;
124
1535-1542
- 19
Orr W C, Eiken T, Pegram V et al..
A laboratory validation study of a portable system for remote recording of sleep related
respiratory disorders.
Chest.
1994;
105
160-162
- 20
Mykytyn I J, Sajkov D, Neill A M et al..
Portable computerized polysomnography in attended and unattended settings.
Chest.
1999;
115
114-122
- 21
Portier F, Portmann A, Czernichow P et al..
Evaluation of home versus laboratory polysomnography in the diagnosis of sleep apnea
syndrome.
Am J Respir Crit Care Med.
2000;
162
814-818
- 22
Ballester E, Solans M, Vila X et al..
Evaluation of a portable respirator recording device for detecting apneas and hypopnoeas
in subjects from a general population.
Eur Respir J.
2000;
16
123-127
- 23
Claman D, Murr A, Trotter K.
Clinical validation of the Bedbugg in detection of obstructive sleep apnea.
Otolaryngol Head Neck Surg.
2001;
125
227-230
- 24
Emsellem H, Corson W, Rappaport B et al..
Verification of sleep apnea using a portable sleep apnea screening device.
South Med J.
1990;
83
748-752
- 25
Ficker J H, Wiest G H, Wilpert J, Fuchs F S, Hahn E G.
Evaluation of a portable recording device (Somnocheck) for use in patients with suspected
obstructive sleep apnoea.
Respiration.
2001;
68
307-312
- 26
Man G, Kang B.
Validation of a portable sleep apnea monitoring device.
Chest.
1995;
108
388-393
- 27
Redline S, Tosteson T, Boucher M et al..
Measurement of sleep-related breathing disturbances in epidemiologic studies. Assessment
of the validity and reproducibility of a portable monitoring device.
Chest.
1991;
100
1281-1286
- 28
Verse T, Pirsig W, Junge-Hulsing B et al..
Validation of the POLY-MESAM seven-channel ambulatory recording unit.
Chest.
2000;
117
1613-1618
- 29
White D, Gibb T, Wall J et al..
Assessment of accuracy and analysis time of a novel device to monitor sleep and breathing
in the home.
Sleep.
1995;
18
115-126
- 30
Zucconi M, Ferini-Strambi L, Castronovo V et al..
An unattended device for sleep-related breathing disorders: validation study in suspected
obstructive sleep apnoea syndrome.
Eur Respir J.
1996;
9
1251-1256
- 31
Dingli K, Coleman E L, Vennelle M et al..
Evaluation of a portable device for diagnosing the sleep apnoea/hypopnoea syndrome.
Eur Respir J.
2003;
21
253-259
- 32
Ancoli-Israel S, Mason W, Coy T et al..
Evaluation of sleep disordered breathing with unattended recording: the Nightwatch
System.
J Med Eng Technol.
1997;
21
10-14
- 33
Whittle A T, Finch S P, Mortimore I L et al..
Use of home sleep studies for diagnosis of the sleep apnoea/hypopnoea syndrome.
Thorax.
1997;
52
1068-1073
- 34
Parra O, Garcia-Esclasans N, Montserrat J et al..
Should patients with sleep apnoea/hypopnoea syndrome be diagnosed and managed on the
basis of home sleep studies?.
Eur Respir J.
1997;
10
1720-1724
- 35
Golpe R, Jimenez A, Carpizo R.
Home sleep studies in the assessment of sleep apnea/hypopnea syndrome.
Chest.
2002;
122
1156-1161
- 36
Zamarron C, Gude F, Barcala J, Rodriguez J R, Romero P V.
Utility of oxygen saturation and heart rate spectral analysis obtained from pulse
oximetric recordings in the diagnosis of sleep apnea syndrome.
Chest.
2003;
123
1567-1576
- 37
Raymond B, Cayton R M, Chappell M J.
Combined index of heart rate variability and oximetry in screening for the sleep apnoea/hypopnoea
syndrome.
J Sleep Res.
2003;
12
53-61
- 38
Roche N, Herer B, Roig C, Huchon G.
Prospective testing of two models based on clinical and oximetric variables for prediction
of obstructive sleep apnea.
Chest.
2002;
121
747-752
- 39
Hussain S F, Fleetham J A.
Overnight home oximetry: can it identify patients with obstructive sleep apnea-hypopnea
who have minimal daytime sleepiness?.
Respir Med.
2003;
97
537-540
- 40
Davila D G, Richards K C, Marshall B L et al..
Oximeter's acquisition parameter influences the profile of respiratory disturbances.
Sleep.
2003;
26
91-95
- 41
Davila D G, Richards K C, Marshall B L et al..
Oximeter performance: the influence of acquisition parameters.
Chest.
2002;
122
1654-1660
- 42
Wiltshire N, Kendrick A, Catterall J.
Home oximetry studies for diagnosis of sleep apnea/hypopnea syndrome. Limitation of
memory storage capabilities.
Chest.
2001;
120
384-389
- 43
Pillar G, Bar A, Betito M et al..
An automatic ambulatory device for detection of AASM defined arousals from sleep:
the WP100.
Sleep Med.
2003;
4
207-212
- 44
Bar A, Pillar G, Dvir I, Sheffy J, Schnall R P, Lavie P.
Evaluation of a portable device based on peripheral arterial tone for unattended home
sleep studies.
Chest.
2003;
123
695-703
- 45 Rechtschaffen A, Kales A. A Manual of Standardized Terminology, Techniques, and
Scoring System for Sleep Stages of Human Subjects. Los Angeles; Brain Information
Service 1968
- 46
Anonymous.
EEG arousals: scoring rules and examples: a preliminary report from the Sleep Disorders
Atlas Task Force of the American Sleep Disorders Association.
Sleep.
1992;
15
173-184
- 47
Gould G A, Whyte K F, Rhind G B et al..
The sleep hypopnea syndrome.
Am Rev Respir Dis.
1988;
137
895-898
- 48
Guilleminault C, Stoohs R, Clerk A, Cetel M, Maistros P.
A cause of excessive daytime sleepiness: the upper airway resistance syndrome.
Chest.
1993;
104
781-787
- 49
Heitman S J, Atkar R S, Hajduk E A, Wanner R A, Flemons W W.
Validation of nasal pressure for the identification of apneas/hypopneas during sleep.
Am J Respir Crit Care Med.
2002;
166
386-391
- 50
Norman R G, Ahmed M M, Walsleben J A, Rapoport D M.
Detection of respiratory events during NPSG: nasal cannula/pressure sensor versus
thermistor.
Sleep.
1997;
20
1175-1184
- 51
Littner M R, McGinty D J, Arand D L.
Determinants of oxygen desaturation in the course of ventilation during sleep in chronic
obstructive pulmonary disease.
Am Rev Respir Dis.
1980;
122
849-857
- 52
Chesson A L, Ferber R A, Fry J M et al..
Standards of Practice Committee Task Force. Practice parameters for the indications
for polysomnography and related procedures.
Sleep.
1997;
20
406-422
- 53
Chesson Jr A L, Berry R B, Pack A.
Practice parameters for the use of portable monitoring devices in the investigation
of suspected obstructive sleep apnea in adults.
Sleep.
2003;
26
907-913
- 54
Montserrat J M, Alarcón A, Lloberes P, Ballester E, Fornas C, Rodriguez-Roisin R.
Adequacy of prescribing nasal continuous positive airway pressure therapy for the
sleep apnoea/hypopnoea syndrome on the basis of night time respiratory recording variables.
Thorax.
1995;
50
969-971
- 55
Gurubhagavatula I, Maislin G, Pack A I.
An algorithm to stratify sleep apnea risk in a sleep disorders clinic population.
Am J Respir Crit Care Med.
2001;
164
1904-1909
- 56
Flemons W W, Whitelaw W A, Brant R, Remmers J E.
Likelihood ratios for a sleep apnea clinical prediction rule.
Am J Respir Crit Care Med.
1994;
150
1279-1285
- 57
Viner S, Szalai J P, Hoffstein V.
Are history and physical examination a good screening test for sleep apnea?.
Ann Intern Med.
1991;
115
356-359
- 58
Netzer N C, Stoohs R A, Netzer C M et al..
Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome.
Ann Intern Med.
1999;
131
485-536
- 59
Kushida C A, Efron B, Guilleminault C.
A predictive morphometric model for the obstructive sleep apnea syndrome.
Ann Intern Med.
1997;
127(8 Pt 1)
581-587
- 60
Tsai W H, Remmers J E, Brant R, Flemons W W, Davies J, Macarthur C.
A decision rule for diagnostic testing in obstructive sleep apnea.
Am J Respir Crit Care Med.
2003;
167
1427-1432
- 61
Berry R B, Parish J M, Hartse K M.
The use of auto-titrating continuous positive airway pressure for treatment of adult
obstructive sleep apnea. An American Academy of Sleep Medicine review.
Sleep.
2002;
25
148-173
- 62
Littner M, Hirshkowitz M, Davila D et al..
Standards of Practice Committee of the American Academy of Sleep Medicine. Practice
parameters for the use of auto-titrating continuous positive airway pressure devices
for titrating pressures and treating adult patients with obstructive sleep apnea syndrome.
An American Academy of Sleep Medicine report.
Sleep.
2002;
25
143-147
- 63
Senn O, Brack T, Matthews F, Russi E W, Bloch K E.
Randomized short-term trial of two autoCPAP devices versus fixed continuous positive
airway pressure for the treatment of sleep apnea.
Am J Respir Crit Care Med.
2003;
168
1506-1511
- 64
Reuven H, Schweitzer E, Tarasiuk A.
A cost-effectiveness analysis of alternative at-home or in-laboratory technologies
for the diagnosis of obstructive sleep apnea syndrome.
Med Decis Making.
2001;
21
451-458
Michael R LittnerM.D.
VA Medical Center, (111P), Bldg. 200
Rm. 3534, 16111 Plummer St.
Sepulveda, CA 91343
Email: mlittner@ucla.edu