PRACTICE PARAMETERS FOR THE INDICATIONS FOR POLYSOMNOGRAPHY AND RELATED PROCEDURES

These clinical guidelines, which have been reviewed and approved by th e Board of Directors of the American Sleep Disorders Association, prov ide recommendations for the practice of sleep medicine in North Americ a regarding the indications for polysomnography in the diagnosis of sl eep disorders. Diagnostic categories that are considered include the f ollowing: sleep-related breathing disorders; neuromuscular disorders a nd sleep-related symptoms; chronic lung disease; narcolepsy; parasomni as; sleep-related epilepsy; restless legs syndrome; periodic limb move ment disorder; depression with insomnia; and circadian rhythm sleep di sorders. Whenever possible, conclusions are based on evidence from rev iew of the literature. Where scientific data are absent, insufficient, or inconclusive, recommendations are based on consensus of opinion. T he Standards of Practice Committee of the American Sleep Disorders Ass ociation appointed a task force to review the topic, the indications f or polysomnography and related procedures. Based on the review and on consultation with specialists, the subsequent recommendations were dev eloped by the Standards of Practice Committee and approved by the Boar d of Directors of the American Sleep Disorders Association. Polysomnog raphy is routinely indicated for the diagnosis of sleep-related breath ing disorders; for continuous positive airway pressure (CPAP) titratio n in patients with sleep-related breathing disorders; for documenting the presence of obstructive sleep apnea in patients prior to laser-ass isted uvulopalatopharyngoplasty; for the assessment of treatment resul ts in some cases; with a multiple sleep latency test in the evaluation of suspected narcolepsy; in evaluating sleep-related behaviors that a re violent or otherwise potentially injurious to the patient or others ; and in certain atypical or unusual parasomnias. Polysomnography may be indicated in patients with neuromuscular disorders and sleep-relate d symptoms: to assist in with the diagnosis of paroxysmal arousals or other sleep disruptions thought to be seizure-related; in a presumed p arasomnia or sleep-related epilepsy that does not respond to conventio nal therapy; or when there is a strong clinical suspicion of periodic limb movement disorder. Polysomnography is not routinely indicated to diagnose chronic lung disease; in cases of typical, uncomplicated, and noninjurious parasomnias when the diagnosis is clearly delineated; fo r patients with epilepsy who have no specific complaints consistent wi th a sleep disorder; to diagnose or treat restless legs syndrome; for the diagnosis of circadian rhythm sleep disorders: or to establish a d iagnosis of depression.