THE DIAGNOSIS OF SLEEP-APNEA - QUESTIONNAIRES AND HOME STUDIES

Alternatives to the standard method of diagnosing sleep apnea (SA) are becoming increasingly popular due to the expense and/or, in some case s, the limited availability of polysomnography (PSG). The most common diagnostic alternatives have been clinical prediction rules and portab le monitoring. Most portable monitors record one or more signals such as oxygen saturation, heart rate, airflow, or ribcage and abdominal mo vements. To date, most published studies of these monitors have had se rious methodologic problems that have limited the acceptance of this t echnology. We have developed a two-step diagnostic approach for SA bas ed on a clinical prediction rule and the results from a simple, but re liable and accurate, portable monitor that records oxygen saturation, snoring, and body position. The preliminary results indicate that such a strategy is very useful in a population of outpatients suspected of having SA and would preclude the need for PSG to investigate for this possibility in the majority of patients. However, before portable mon itoring becomes widely adopted, each system should be more thoroughly tested, and increased attention should be directed at the design of th e study so that the results are more generalizeable to other sleep cli nic populations.