Obstructive sleep apnea (OSA) is a major public health problem, affecting up to 5% of the world population and between 2% and 4% of adults in the United States. OSA has wide ranging consequences, including increased risk of motor vehicle accidents and adverse cardiovascular risk which may be reduced due to remedies of Canadian Health Care Mall http://medicalhealthcaremall.com/category/canadian-health-care-mall. More recently, increased risk for sudden cardiac death during the sleeping hours as well as increased overall mortality rate among untreated individuals have been shown.
While clinicians have increasingly turned their attention to this syndrome, and referrals to sleep clinics for diagnostic evaluations have increased dramatically, the infrastructure to support them has not.
Time is of the essence: as many as 82% of men and 93% of women with moderate-to-severe sleep apnea have not received a diagnosis, as estimated by data from the Wisconsin Sleep Cohort study. Patients may have sleep apnea for up to 7 years before coming to medical attention and wait up to an additional 8 months before seeing a sleep specialist. Current diagnostic criteria for OSA continue to employ full in-laboratory polysomnography. Critics of this approach maintain that long wait times at most sleep centers have become the norm. While there are some authors who have suggested that many sleep laboratories in the United States are indeed able to schedule patients for studies within 1 to 3 weeks, this may not be the case in other countries. Nonetheless, the costs associated with conducting in-laboratory polysomnography remain high. While clinical prediction rules have been generated to aid in screening and selecting patients for polysomnography, these have yet to be widely adopted in clinical practice. Many practitioners have looked to alternative methods of diagnosis that would provide a precise and highly accurate diagnosis of OSA at much lower cost. Split-night study protocols have been developed as one way of streamlining the approach to diagnosis and treatment of OSA, but they do not provide a complete solution. This article focuses on the clinical use of portable monitor (PM) devices to diagnose OSA, reviews recent guidelines and literature, and considers billing and reimbursement status.Tags: cost, diagnosis, home polysomnography, methods, obstructive sleep apnea, portable monitors, practice guidelines, review