Systemic Review: Sleep Apnea
1.0 INTRODUCTION/BACKGROUND
Sleep apnea is a common disorder that affects both children and adults. It is characterized by periods of breathing cessation (apnea) and periods of reduced breathing (hypopnea). Both types of events have similar pathophysiology and are generally considered to be equal with respect to their impact on patients.1 The most common form of sleep apnea, called obstructive sleep apnea, is caused by the partial or complete collapse of the upper airway. There are several methods of quantifying the severity of the disorder such as measuring the number of apneas and hypopneas per hour of sleep (ie, the apnea-hypopnea index [AHI]), the severity of oxygen desaturation during sleep, or the severity of the most commonly associated symptom, daytime somnolence. The prevalence of an AHI of ≥ 5 was 24% in men and 9% in women aged 30 to 60 years in the Wisconsin Sleep Cohort Study.2 The prevalence of symptomatic sleep apnea (ie, AHI of ≥ 5 with excessive daytime somnolence) for men and women was 4% and 2%, respectively.2 The standard approach to diagnosis is in-laboratory, technician-attended polysomnography that monitors, at a minimum, sleep time and respiration. Polysomnography requires technical expertise, and is labor-intensive and time-consuming. Timely access is a problem for many patients, the majority of whom continue to have undiagnosed sleep apnea. In the Wisconsin sleep cohort study,3 93% of women and 82% of men with moderate-to-severe sleep apnea did not receive diagnoses. Thus, there is a growing interest in alternative approaches to diagnosis, such as portable monitoring, that have been proposed as a substitute for polysomnography in the diagnostic assessment of patients with suspected sleep apnea. The term portable monitoring encompasses a wide range of devices that can record as many signals as does attended polysomnography or only one signal, such as with oximetry (see section 1.1). When EEG and electromyogram (EMG) signals are recorded, sleep staging can be performed that provides a denominator for the AHI. More commonly, EEG and EMG signals are not recorded by portable monitors, in which case breathing events are usually quantified per hour of monitoring time as a respiratory disturbance index (RDI). The use of portable monitoring to assess patients suspected of having sleep apnea is controversial and has been the subject of previous reviews of the literature.4 5 6 7 8 Since the last review was completed, there have been additional research studies published and more standardized methods developed for rating the evidence of studies on diagnostic tests.
Guideline Ranking & Disclaimer
Rank | Definition |
|---|---|
| 1 | This guideline is new and represents the best available evidence at this time. It will be reviewed on an annual basis to determine if it remains current. |
| 2 | This guideline is reviewed on an annual basis and there have been new studies published since the guideline was developed. However, the Health and Science Policy (HSP) Committee determined that these studies are not sufficient to warrant changing the guideline at this time. The information contained in this guideline provides the user with the best evidence available at the time the guideline was published. Readers are encouraged to search the current literature as a supplement to using this guideline. |
| 3 | This guideline is reviewed on an annual basis. The HSP Committee determined that new studies have been published that warrant an update of the (fill in) chapter/section of this practice guideline. The HSP Committee also determined that the remainder of the chapters/sections does not require updating and these recommendations remain current. |
| 4 | This guideline is reviewed on an annual basis. The HSP Committee determined that new data are available that are sufficient to potentially change guideline recommendations and a full revision is warranted. |
| 5 | This guideline has been reviewed on an annual basis. The HSP Committee has decided it is outdated; however, it has been retained for historical and/or educational purposes. These guidelines should be used with caution for clinical decision-making purposes. |
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