This is the current release of the guideline.

Level of recommendation (Standard, Guideline, and Option) definitions are provided at the end of the "Major Recommendation" field.

Type 2 Portable Monitoring (PM) Devices: Comprehensive Portable Polysomnography

1. The clinical use of Type 2 PM devices in the attended setting is not recommended to evaluate patients with suspected obstructive sleep apnea (OSA). (Option)
2. The clinical use of Type 2 PM devices in the unattended setting is not recommended to evaluate patients with suspected OSA. (Option)

Type 3 PM Devices: Modified Portable Sleep Apnea Testing

Recommendations concerning the use of Type 3 PM devices to reduce the probability that a patient has an apnea-hypopnea index (AHI) less than 15 (i.e., rule out a diagnosis of OSA at a level selected by the review-paper authors for their statistical cutoff; this is also one of the levels set by Medicare to reflect a level of significance)

3. The use of some Type 3 PM devices in an attended setting can decrease the probability that the patient has an AHI greater than 15. (Standard)
4. The use of Type 3 PM devices in an unattended setting is not recommended to decrease the probability that the patient has an AHI greater than 15. (Guideline)

Recommendations concerning the use of Type 3 PM devices to increase the probability that a patient has an AHI greater than 15 (i.e., rule in a diagnosis of OSA at a level selected by the review-paper authors for their statistical cutoff; this is also one of the levels set by Medicare to reflect a level of significance)

5. Some Type 3 PM devices can be used in an attended setting to increase the probability that a patient has an AHI greater than 15. (Standard)
6. The use of Type 3 PM devices in an unattended setting is not recommended to increase the probability that a patient has an AHI greater than 15. (Guideline)

Recommendations concerning the use of Type 3 PM devices to both increase and decrease the likelihood that a patient has a diagnosis of OSA with a single threshold, which is the most practical clinical use.

7. The use of Type 3 PM devices may be acceptable in an attended in-laboratory setting to both rule in and rule out a diagnosis of OSA. Such a use, however, would require limitations (see original guideline document). (Flemons et al., 2003; sections 4.1.3 and 4.3.2.4) (Standard)
8. The use of Type 3 PM devices in an unattended setting is not recommended to rule in and rule out a diagnosis of OSA. (Guideline)

Type 4 PM Devices: Continuous Single Or Dual Bioparameter Recording

Recommendations concerning the use of Type 4 PM devices in the attended setting to increase, decrease, or both increase and decrease the probability of the patient having an AHI greater than 15.

9. The routine use of Type 4 PM devices with oximetry and at least one other airflow parameter in an attended setting is not recommended to increase the probability that a patient has an AHI greater than 15. (Option)
10. The routine use of Type 4 PM devices with oximetry and at least one other airflow parameter in an attended setting is not recommended to decrease the probability that a patient has an AHI greater than 15. (Option)
11. The routine use of Type 4 PM devices with oximetry and at least one other airflow parameter is not recommended in an attended setting to both increase and decrease the probability that a patient has an AHI greater than 15. (Option)

Recommendations concerning the use of Type 4 PM devices in the unattended setting to increase, decrease, or both increase and decrease the probability of a patient having an AHI greater than 15.

12. The use of Type 4 PM devices in the unattended setting with oximetry and one other airflow parameter is not recommended for diagnosing OSA or confirming that a patient has an AHI greater than or less than 15. (Guideline)

Areas Requiring Special Attention

13. The use of PM devices is not recommended for general screening or clinical use without available knowledge of the patient's sleep-related history and complaints.
14. The use of PM devices is not recommended in patients with comorbid conditions or secondary sleep complaints because there is little evidence to support the use of PM devices in evaluating these conditions or to diagnose other sleep disorders.
15. Even when PM devices are noted as being possibly useful, the general use of all types of devices across that category is not necessarily recommended. The laboratory should confirm that the commercial device selected in a category has specific studies documenting its performance and that it conforms to the use characteristics of that category as a whole.
16. The review of raw data and the use of manual scoring for interpreting data from PM devices are recommended.
17. Physicians with sleep training and familiarity with the devices and their limitations should interpret studies generated by PM devices and should review the raw data, as noted above. Trained and qualified technicians should perform any technical scoring.

Definitions:

Standard: This is a generally accepted patient-care strategy that reflects a high degree of clinical certainty. The term standard generally implies the use of Level I evidence, which directly addresses the clinical issue, or overwhelming Level II evidence.

Guideline: This is a patient-care strategy that reflects a moderate degree of clinical certainty. The term guideline implies the use of Level II evidence or a consensus of Level III evidence.

Option: This is a patient-care strategy that reflects uncertain clinical use. The term option implies either inconclusive or conflicting evidence or conflicting expert opinion.

None provided

This practice parameters paper is based entirely on the evidence presented in the review paper and is neither a consensus paper nor a statement of acceptable clinical practice based on expert opinion.

Not applicable: The guideline was not adapted from another source.

2003 Nov 1

American Academy of Sleep Medicine - Professional Association
American College of Chest Physicians - Medical Specialty Society
American Thoracic Society - Medical Specialty Society

When the American Academy of Sleep Medicine (AASM) was in the process of conducting a review of the literature that had been published since the 1994 and 1997 practice parameters were developed, the American Thoracic Society (ATS) and the American College of Chest Physicians (ACCP) were also considering undertaking similar projects on this complex issue. After discussion at an ACCP-hosted conference on portable monitoring (PM) in September 2002, the 3 groups joined forces in this process. Additional groups that expressed a willingness to assist with input were the National Association for the Medical Directors of Respiratory Care and the Australasian Sleep Association.

American Academy of Sleep Medicine
American Thoracic Society
American College of Chest Physicians

Representative appointed by the American Academy of Sleep Medicine (AASM), American College of Chest Physicians (ACCP), and American Thoracic Society (ATS)

Guideline Authors: Andrew L. Chesson, Jr, MD (Louisiana State University Health Sciences Center – Shreveport, Shreveport, Louisiana); Richard B. Berry, MD (Malcom Randall VAMC/University of Florida, Gainesville, Florida); Allan Pack, MD, PhD (Center for Sleep and Respiratory Neurobiology, University of Pennsylvania, Philadelphia, Pennsylvania)

The detailed conflict of interest policy adopted is discussed in the review paper. It is noted that all three members of the Guideline Writing Committee are directors of academic sleep disorders centers and are experienced in the use of both polysomnography and various portable monitoring devices in their clinical and/or research work, although none participate in industry-sponsored research trials on portable monitoring (PM) devices for the diagnosis of apnea, or have financial interests outlined in the review paper in the conflict of interest exclusions.

This is the current release of the guideline.

None available

This NGC summary was completed by ECRI on March 18, 2004. The information was verified by the guideline developer on April 22, 2004.

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions. Please contact the American Academy of Sleep Medicine for information regarding reproduction of guidelines.