A systematic review of the literature on the use of portable monitoring (PM) had been compiled between 1994 and 1997 by the American Academy of Sleep Medicine (AASM, formerly the American Sleep Disorders Association), the Agency for Healthcare Research and Quality (AHRQ, formerly the Agency for Healthcare Policy and Research) and ECRI (Emergency Care Research Institute).
The literature search for this guideline focused on articles published since 1997. The initial search was completed June 26, 2001. The bibliographies from two American Sleep Disorder Association reviews also were searched for relevant articles. Several search strategies were used, focusing on screening, diagnosis, and costs. The search strategy used the headings "Screening" (including the terms "Reproducibility of Results," or "Predictive Value of Tests," or "Sensitivity and Specificity"), "Diagnosis" for finding citations involving the terms "Sleep Apnea Syndromes," "Sleep Apnea (Obstructive)," "Oximetry," "Polysomnography," "Monitoring Physiologic," "Airway Resistance," "Upper Airway Resistance Syndrome," "Respiratory Disturbance Index," "Autoset," "Snoring," or "Respiratory Event-Related Arousals." The term "Home Care Services" also was used to identify citations. For the heading "Screening," the MEDLINE search identified 157 citations, and for "Diagnosis," the MEDLINE search identified 180 citations. The use of the terms "Home Care Services" and "Polysomnography" identified 14 additional citations.
For costs, the Medical Subject Heading (MeSH) heading "Costs and Cost Analysis" was exploded to include the terms "Cost Benefit Analysis," "Cost Allocation," Cost Control," "Cost Savings," "Cost Sharing," "Cost of Illness," "Health Care Costs," and "Health Expenditures." The MEDLINE search was conducted from 1997 to the present (June 26, 2001) and identified 35 citations.
The inclusion criteria were as follows:
- Male/female patients, ages >18 years, with ANY diagnosis of obstructive sleep apnea
- Study published in English, no race or gender restrictions
- Portable device used for diagnosis
- Polysomnography or other acceptable objective test used for the diagnosis of sleep apnea
- After completion of the study, each analysis group was >10 subjects
The exclusion criteria were as follows:
- Studies in children
- Studies in languages besides English
- Reviews, meta-analyses, case reports, abstracts, letters, and editorials
The titles of retrieved articles were reviewed, and the abstract of any article the title of which mentioned diagnosis of sleep apnea was reviewed for relevance to this review. If there was ambiguity about the study meeting the inclusion/exclusion criteria, the full article was reviewed. The reference lists of articles included in this review were scanned to determine other possible articles that should be included.
The guideline developer's Evidence Review Committee elected to have the search updated to include articles up to December 31, 2001; that identified two additional articles.