18 Nov Sleep Disorders: Accuracy of Portable Sleep Tests
MedicalResearch.com: What are the main findings of the study?
Dr. El Shayeb: Our study shows that limited channel level-3 portable devices, used at home, are of good diagnostic value compared to the comprehensive reference-standard level-1 sleep tests conducted in lab in the diagnosis of obstructive sleep apnea (the most common subtype of sleep disordered breathing.) Were any of the findings unexpected?
None of the findings were unexpected. Level-3 portable devices are commonly used in clinical practice; however, this technology has been widely disseminated, without solid evidence about their diagnostic performance or the subpopulation of sleep disordered breathing patients who are most appropriately diagnosed with them. Our research provides a high level of evidence on the diagnostic performance of these devices, and most importantly, defines the subgroup of patients who are eligible for this test (patients with simple obstructive sleep apnea, and without significant comorbidities.)
MedicalResearch.com: What should clinicians and patients take away from your report?
Dr. El Shayeb: Family doctors now have the high level evidence that shows the subgroup of sleep disordered breathing patients who are most appropriately diagnosed with these devices. Our research describes in detail this patient group (those with a high pretest probability of having moderate to severe obstructive sleep apnea and without significant comorbidities.) Family doctors should exercise due diligence in assessing patients presenting to them with one or more of the suggestive symptoms (e.g. snoring or daytime sleepiness) to properly refer them to the appropriate test. The good news for patients, on the other hand, is that by redirecting the proper patient group to the level-3 sleep tests, adopting level-3 portable devices is expected to reduce the burden on level-1 sleep facilities and subsequently reduce the long wait times for level-1. Therefore, Level-1 sleep tests will be saved for patients who are in real need for this more comprehensive type of testing (those who are expected to have other forms of sleep disordered breathing or accompanying comorbidities.) In general, patients are expected to have an accelerated access to diagnosis and subsequent treatment. Either via the convenient portable devices used at home or timelier schedule for level 1 tests.
What recommendations do you have for future research as a result of this study?
Dr. El Shayeb: With the evolution of the technology, level-3 portable sleep devices are continually improving, with new capabilities to capture data and reduce artifact. Many new devices do not fit well in the level-1 through 4 classification scheme. The SCOPER (Sleep, Cardiovascular, Oximetry, Position, Effort, and Respiratory) system may help to assess these devices in future studies by allowing comparison of the features and measurements they capture.
Diagnostic accuracy of level 3 portable sleep tests versus level 1 polysomnography for sleep-disordered breathing: a systematic review and meta-analysis.
Shayeb ME, Topfer LA, Stafinski T, Pawluk L, Menon D.
CMAJ. 2013 Nov 11. [Epub ahead of print]