Conclusions

Polysomnography remains the standard for diagnosis of sleep apnea and other disorders of sleep. However, depending on the prevalence of sleep apnea in the population in question and the diagnostic device used, an ambulatory strategy could easily be adopted. Patients can be stratified according to history (symptoms), physical examination, and clinical prediction strategies. The probability of sleep apnea can be estimated, and when there is a moderate-to-high probability, portable monitoring can confirm the suspicion and subjects can immediately go on to treatment. If there is no sleep apnea and patients are asymptomatic, it can be argued that no further testing is necessary and only follow-up is required. Symptomatic patients, regardless of their pretest probability, would go on to polysomnography. If the pretest probability for sleep apnea is low, polysomnography would be used only for symptomatic patients. While we await long-term outcome studies of such an approach, individual clinicians will have to apply this algorithm within the confines of the local resources, patient expectations, and clinical practice.

Sleep Apnea

Sleep Apnea

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