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Portable Monitors in the Diagnosis of Obstructive Sleep Apnea^*

^* From the Division of Sleep Medicine, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA.

Correspondence to: Murtuza Ahmed, MD, Division of Sleep Medicine, Department of Medicine, University of Pennsylvania School of Medicine, 3624 Market St, Suite 205, Philadelphia, PA 19104; e-mail: Murtuza.Ahmed{at}uphs.upenn.edu

Abstract

The use of portable monitors (PM) devices has been demonstrated in a wide variety of investigational settings with varying results. While most devices correlate very well with in-laboratory polysomnography, some still misclassify a significant numbers of patients and have lower sensitivity. In addition, the failure rate of PM devices is higher than that of in-laboratory polysomnography, requiring repeated investigations. Nonetheless, these devices may reduce the waiting time for diagnosis and could potentially decrease costs. Cost-effectiveness studies have yet to demonstrate an advantage to using PM devices, although their employed modeling techniques may not accurately reflect prevailing practices. The majority of third-party payers do not reimburse unattended studies and consider them still to be investigational. Some health maintenance organizations have begun to recognize PM-based studies in their diagnostic algorithms and will cover their cost; others may do so on a case-by-case basis. There continues to be a dearth of evidence to support widespread implementation of PM devices for use within the general population. Larger-scale validation studies in patients with lower pretest probabilities and a wide range of comorbidities are needed.

Key Words: cost • diagnosis • home polysomnography • methods • obstructive sleep apnea • portable monitors • practice guidelines • review

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