Sleep Disorders and Sleep Deprivation: An Unmet Public

Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem
http://www.nap.edu/catalog/11617.html
ENSURING ADEQUATE DIAGNOSIS AND TREATMENT 225
for release in 2006, should provide important advances for the diagnosis of
chronic sleep loss and sleep disorders.
Summary of Formal Evaluation Reviews
Three recent in-depth reviews have been performed to examine the
effectiveness of portable monitoring devices (Ross et al., 2000; ATS, 2004;
Tice, 2005). As described above, these reports were largely aimed at evaluating
the literature regarding the accuracy of clinical diagnosis relative to
reference in lab polysomnography, with some attempt at also evaluating
the literature relative to cost-effectiveness and clinical prediction. In 1998,
the Agency for Healthcare Research and Quality performed a literature
review and meta-analysis on studies of portable monitoring for OSA.
The review concluded that at the time there was insufficient evidence to
make firm recommendations for use of portable monitoring for the diagnosis
of sleep apnea (Ross et al., 2000).
An executive summary on the systematic review and practice parameters
for portable monitoring in the investigation of suspected sleep apnea
in adults was published in 2004 by an evidence review committee consisting
of members from the American Thoracic Society, the American College of
Chest Physicians, and the American Academy of Sleep Medicine (ATS, 2004;
Flemons and Littner, 2003). In that summary, the following recommendations
were made:
• Given the available data, the use of portable device was not recommended
for general screening.
• The use of portable devices was not recommended in patients with
comorbid conditions or secondary sleep complaints.
• The use of portable devices should require review of raw data by
trained sleep specialists.
The review committee also recognized the need for further development
of portable devices and suggested several goals for future research. It
was found that most studies on portable monitoring were performed primarily
on white males with OSA who had few comorbidities. The evidence
review committee recommended that future studies should include more
diverse populations, other than patients with sleep apnea, that are not subject
to selection bias. Additional recommendations were that future studies
should address clinical predictive algorithms in combination with portable
monitoring in the diagnosis of sleep apnea, and study design should assess
the cost-effectiveness and outcomes associated with different diagnostic and
management strategies.
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