Chest
Volume 124, Issue 4, October 2003, Pages 1543-1579
Journal home page for Chest

Reviews
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

https://doi.org/10.1378/chest.124.4.1543Get rights and content

Section snippets

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

Literature Review

The ATS/ACCP/AASM working group contracted with the RTI-UNC evidence practice center to conduct a systematic review of the literature and to abstract data in a standard fashion from relevant studies that allowed summaries of their findings to be generated by the ERC. The RTI-UNC team followed the recommended methods for conducting systematic reviews, which emphasized comprehensive literature search and evaluation, and used standardized procedures for the review (and its documentation) of

Number of Articles Reviewed/Rejected

The initial literature search resulted in 59 original research articles being identified that met the inclusion criteria. Of these, 46 articles were selected for review by the evidence practice center.10111213141516171819202122232425262729303132333436373839404142434445464748495051525354555657 Thirteen articles were not included68697071727374757677787980 for the following reasons: they were reports of older monitors for which more recent research had been published (one article) or were known to

Primary Questions

There are many causes of variability in results between portable monitors and polysomnography. A simultaneous comparison of portable monitoring with polysomnography (sleep laboratory-attended) controls for a number of conditions that nonsimultaneous studies do not and, as such, provides an estimate of what might ideally be expected during home-unattended portable monitoring. The comparison of portable monitoring performed in the home-unattended setting with sleep laboratory polysomnography may

DIRECTIONS/NEED FOR FUTURE RESEARCH

This review has highlighted several areas that are necessary to address in future studies (sections 1.1.3, 1.3, 1.4, 1.5, 2.3, 2.4, 3.4, and 4.2.4) and that have been discussed under general comments and limitations in section 4.3.

First page preview

First page preview
Click to open first page preview

References (86)

  • N Douglas et al.

    Clinical value of polysomnography

    Lancet

    (1992)
  • C Zamarron et al.

    Screening of obstructive sleep apnoea: heart rate spectral analysis of nocturnal pulse oximetric recording

    Respir Med

    (2001)
  • M Reda et al.

    Pharyngoesophageal pressure monitoring in sleep apnea syndrome

    Otolaryngol Head Neck Surg

    (2001)
  • D Claman et al.

    Clinical validation of the Bedbugg™ in detection of obstructive sleep apnea

    Otolaryngol Head Neck Surg

    (2001)
  • DL Simel et al.

    Likelihood ratios with confidence: sample size estimation for diagnostic test studies

    J Clin Epidemiol

    (1991)
  • R Farney et al.

    Ear oximetry to detect apnea and differentiate rapid eye movement (REM) and non-REM (NREM) sleep: screening for the sleep apnea syndrome

    Chest

    (1986)
  • E Svanborg et al.

    A limited diagnostic investigation for obstructive sleep apnea syndrome: oximetry and static charge sensitive bed

    Chest

    (1990)
  • O Le Bon et al.

    Mild to moderate sleep respiratory events: one negative night may not be enough

    Chest

    (2000)
  • MR Littner

    The diagnosis of OSA: where do we draw the line [editorial]?

    Chest

    (2000)
  • AM Namen et al.

    Increased physician-reported sleep apnea: the National Ambulatory Medical Care Survey

    Chest

    (2002)
  • American Academy of Sleep Medicine

    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)
  • T Young et al.

    The occurrence of sleep-disordered breathing among middle-aged adults

    N Engl J Med

    (1993)
  • T Young et al.

    Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle-aged men and women

    Sleep

    (1997)
  • RA Ferber et al.

    ASDA standards of practice: portable recording in the assessment of obstructive sleep apnea

    Sleep

    (1994)
  • American Sleep Disorders Association

    Practice parameters for the indications for polysomnography and related procedures: Polysomnography Task Force, American Sleep Disorders Association Standards of Practice Committee

    Sleep

    (1997)
  • AL Chesson et al.

    The indications for polysomnography and related procedures

    Sleep

    (1997)
  • SD Ross et al.

    Systematic review of the literature regarding the diagnosis of sleep apnea: evidence report/technology assessment No. 1

    (February 1999)
  • SD Ross et al.

    Systematic review and meta-analysis of the literature regarding the diagnosis of sleep apnea

    Sleep

    (2000)
  • DL Sackett et al.

    Evidence-based medicine: how to practice and teach EBM

    (2000)
  • K Rees et al.

    Detection of apnoeas, hypopnoeas and arousals by the AutoSet in the sleep apnoea/hypopnoea syndrome

    Eur Respir J

    (1998)
  • M Gugger

    Comparison of ResMed AutoSet (version 3.03) with polysomnography in the diagnosis of the sleep apnoea/hypopnoea syndrome

    Eur Respir J

    (1997)
  • P Mayer et al.

    Simultaneous laboratory-based comparison of ResMed Autoset™ with polysomnography in the diagnosis of sleep apnoea/hypopnoea syndrome

    Eur Respir J

    (1998)
  • J Kiely et al.

    Comparison of a limited computerized diagnostic system (ResCare Autoset™) with polysomnography in the diagnosis of obstructive sleep apnoea syndrome

    Eur Respir J

    (1996)
  • P Bradley et al.

    Comparison of polysomnography with ResCare Autoset in the diagnosis of the sleep apnoea/hypopnoea syndrome

    Thorax

    (1995)
  • M Bagnato et al.

    Comparison of AutoSet and polysomnography for the detection of apnea-hypopnea events

    Braz J Med Biol Res

    (2000)
  • M Gugger et al.

    Accuracy of an intelligent CPAP machine with in-built diagnostic abilities in detecting apneas: a comparison with polysomnography

    Thorax

    (1995)
  • B Fleury et al.

    A laboratory validation study of the diagnostic mode of the Autoset™ system for sleep-related respiratory disorders

    Sleep

    (1996)
  • J Fry et al.

    Full polysomnography in the home

    Sleep

    (1998)
  • F Portier et al.

    Evaluation of home versus laboratory polysomnography in the diagnosis of sleep apnea syndrome

    Am J Respir Crit Care Med

    (2000)
  • M Zucconi et al.

    An unattended device for sleep-related breathing disorders: validation study in suspected obstructive sleep apnoea syndrome

    Eur Respir J

    (1996)
  • H Emsellem et al.

    Verification of sleep apnea using a portable sleep apnea screening device

    South Med J

    (1990)
  • S Ancoli-Israel et al.

    Evaluation of sleep disordered breathing with unattended recording: the Nightwatch System

    J Med Eng Technol

    (1997)
  • O Parra et al.

    Should patients with sleep apnoea/hypopnoea syndrome be diagnosed and managed on the basis of home sleep studies?

    Eur Respir J

    (1997)
  • Cited by (487)

    • Emerging technologies and their potential role in sleep medicine

      2023, Encyclopedia of Sleep and Circadian Rhythms: Volume 1-6, Second Edition
    • Association between cyclic variation in the heart rate index and biomarkers of neurodegenerative diseases in obstructive sleep apnea syndrome: A pilot study

      2022, Journal of Clinical Neuroscience
      Citation Excerpt :

      This variation could have been caused by sleep position, the first-night effect, as well as environmental factors. A potential explanation for the difference may also be the habitual night‐to‐night variability; i.e. any variation in time spent in certain sleep positions can considerably affect the AHI and OSAS severity [38]. Because participants must wear complicated examination devices, they are restricted from changing their sleep position during in-hospital PSG recording.

    View all citing articles on Scopus

    Supplemental evidence tables are available online at http://www.chestjournal.org/cgi/content/full/124/4/1543/DC1.

    View full text