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Journal of Clinical Sleep Medicine :... Mar 2017This guideline establishes clinical practice recommendations for the diagnosis of obstructive sleep apnea (OSA) in adults and is intended for use in conjunction with...
INTRODUCTION
This guideline establishes clinical practice recommendations for the diagnosis of obstructive sleep apnea (OSA) in adults and is intended for use in conjunction with other American Academy of Sleep Medicine (AASM) guidelines on the evaluation and treatment of sleep-disordered breathing in adults.
METHODS
The AASM commissioned a task force of experts in sleep medicine. A systematic review was conducted to identify studies, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process was used to assess the evidence. The task force developed recommendations and assigned strengths based on the quality of evidence, the balance of benefits and harms, patient values and preferences, and resource use. In addition, the task force adopted foundational recommendations from prior guidelines as "good practice statements", that establish the basis for appropriate and effective diagnosis of OSA. The AASM Board of Directors approved the final recommendations.
RECOMMENDATIONS
The following recommendations are intended as a guide for clinicians diagnosing OSA in adults. Under GRADE, a STRONG recommendation is one that clinicians should follow under most circumstances. A WEAK recommendation reflects a lower degree of certainty regarding the outcome and appropriateness of the patient-care strategy for all patients. The ultimate judgment regarding propriety of any specific care must be made by the clinician in light of the individual circumstances presented by the patient, available diagnostic tools, accessible treatment options, and resources. Good Practice Statements: Diagnostic testing for OSA should be performed in conjunction with a comprehensive sleep evaluation and adequate follow-up. Polysomnography is the standard diagnostic test for the diagnosis of OSA in adult patients in whom there is a concern for OSA based on a comprehensive sleep evaluation.Recommendations: We recommend that clinical tools, questionnaires and prediction algorithms not be used to diagnose OSA in adults, in the absence of polysomnography or home sleep apnea testing. (STRONG). We recommend that polysomnography, or home sleep apnea testing with a technically adequate device, be used for the diagnosis of OSA in uncomplicated adult patients presenting with signs and symptoms that indicate an increased risk of moderate to severe OSA. (STRONG). We recommend that if a single home sleep apnea test is negative, inconclusive, or technically inadequate, polysomnography be performed for the diagnosis of OSA. (STRONG). We recommend that polysomnography, rather than home sleep apnea testing, be used for the diagnosis of OSA in patients with significant cardiorespiratory disease, potential respiratory muscle weakness due to neuromuscular condition, awake hypoventilation or suspicion of sleep related hypoventilation, chronic opioid medication use, history of stroke or severe insomnia. (STRONG). We suggest that, if clinically appropriate, a split-night diagnostic protocol, rather than a full-night diagnostic protocol for polysomnography be used for the diagnosis of OSA. (WEAK). We suggest that when the initial polysomnogram is negative and clinical suspicion for OSA remains, a second polysomnogram be considered for the diagnosis of OSA. (WEAK).
Topics: Academies and Institutes; Adult; Humans; Polysomnography; Sleep Apnea, Obstructive; Sleep Medicine Specialty; Surveys and Questionnaires
PubMed: 28162150
DOI: 10.5664/jcsm.6506 -
Journal of Clinical Sleep Medicine :... May 2017
Topics: Humans; Polysomnography; Sleep Apnea, Obstructive; Sleep Medicine Specialty; Societies, Medical; United States; Practice Guidelines as Topic
PubMed: 28416048
DOI: 10.5664/jcsm.6576 -
Behavioral Sleep Medicine 2019: To evaluate the performance of a multisensor sleep-tracker (ŌURA ring) against polysomnography (PSG) in measuring sleep and sleep stages. : Forty-one healthy...
: To evaluate the performance of a multisensor sleep-tracker (ŌURA ring) against polysomnography (PSG) in measuring sleep and sleep stages. : Forty-one healthy adolescents and young adults (13 females; Age: 17.2 ± 2.4 years). : Sleep data were recorded using the ŌURA ring and standard PSG on a single laboratory overnight. Metrics were compared using Bland-Altman plots and epoch-by-epoch (EBE) analysis. : Summary variables for sleep onset latency (SOL), total sleep time (TST), and wake after sleep onset (WASO) were not different between ŌURA ring and PSG. PSG-ŌURA discrepancies for WASO were greater in participants with more PSG-defined WASO ( < .001). Compared with PSG, ŌURA ring underestimated PSG N3 (~20 min) and overestimated PSG REM (~17 min; < .05). PSG-ŌURA differences for TST and WASO lay within the ≤ 30 min a-priori-set clinically satisfactory ranges for 87.8% and 85.4% of the sample, respectively. From EBE analysis, ŌURA ring had a 96% sensitivity to detect sleep, and agreement of 65%, 51%, and 61%, in detecting "light sleep" (N1), "deep sleep" (N2 + N3), and REM sleep, respectively. Specificity in detecting wake was 48%. Similarly to PSG-N3 ( < .001), "deep sleep" detected with the ŌURA ring was negatively correlated with advancing age ( = .001). ŌURA ring correctly categorized 90.9%, 81.3%, and 92.9% into PSG-defined TST ranges of < 6 hr, 6-7 hr, > 7 hr, respectively. : Multisensor sleep trackers, such as the ŌURA ring have the potential for detecting outcomes beyond binary sleep-wake using sources of information in addition to motion. While these first results could be viewed as promising, future development and validation are needed.
Topics: Actigraphy; Adolescent; Adult; Female; Humans; Male; Polysomnography; Reproducibility of Results; Sleep; Young Adult
PubMed: 28323455
DOI: 10.1080/15402002.2017.1300587 -
Journal of Clinical Sleep Medicine :... Nov 2013Sleep hygiene recommendations are widely disseminated despite the fact that few systematic studies have investigated the empirical bases of sleep hygiene in the home... (Randomized Controlled Trial)
Randomized Controlled Trial
STUDY OBJECTIVE
Sleep hygiene recommendations are widely disseminated despite the fact that few systematic studies have investigated the empirical bases of sleep hygiene in the home environment. For example, studies have yet to investigate the relative effects of a given dose of caffeine administered at different times of day on subsequent sleep.
METHODS
This study compared the potential sleep disruptive effects of a fixed dose of caffeine (400 mg) administered at 0, 3, and 6 hours prior to habitual bedtime relative to a placebo on self-reported sleep in the home. Sleep disturbance was also monitored objectively using a validated portable sleep monitor.
RESULTS
Results demonstrated a moderate dose of caffeine at bedtime, 3 hours prior to bedtime, or 6 hours prior to bedtime each have significant effects on sleep disturbance relative to placebo (p < 0.05 for all).
CONCLUSION
The magnitude of reduction in total sleep time suggests that caffeine taken 6 hours before bedtime has important disruptive effects on sleep and provides empirical support for sleep hygiene recommendations to refrain from substantial caffeine use for a minimum of 6 hours prior to bedtime.
Topics: Adult; Analysis of Variance; Caffeine; Double-Blind Method; Female; Humans; Male; Polysomnography; Sleep; Time Factors; Wakefulness
PubMed: 24235903
DOI: 10.5664/jcsm.3170 -
Sleep Medicine Clinics Mar 2017This article provides the current state of evidence on the socioeconomic impact of portable testing (PT) for sleep apnea. It seems the traditional in-laboratory... (Review)
Review
This article provides the current state of evidence on the socioeconomic impact of portable testing (PT) for sleep apnea. It seems the traditional in-laboratory polysomnography and the newer home-based PT model for sleep apnea diagnosis both have places in sleep medicine diagnostic algorithm. PT would be cost-effective in a selected group of patients as long as certain criteria, discussed in this article, are carefully considered.
Topics: Humans; Monitoring, Ambulatory; Point-of-Care Testing; Polysomnography; Practice Guidelines as Topic; Sleep Apnea, Obstructive
PubMed: 28159092
DOI: 10.1016/j.jsmc.2016.10.006 -
Arquivos Brasileiros de Cardiologia Aug 2018
Topics: Brazil; Cardiovascular Diseases; Humans; Polysomnography; Sleep Wake Disorders; Societies, Medical
PubMed: 30335871
DOI: 10.5935/abc.20180154 -
Epilepsia Open Sep 2023This study evaluated sleep and respiratory abnormalities, and their relationship with seizures, in adults with developmental and epileptic encephalopathies (DEEs). We...
This study evaluated sleep and respiratory abnormalities, and their relationship with seizures, in adults with developmental and epileptic encephalopathies (DEEs). We studied consecutive adults with DEEs undergoing inpatient video-EEG monitoring and concurrent polysomnography between December 2011 and July 2022. Thirteen patients with DEEs were included (median age: 31 years, range: 20-50; 69.2% female): Lennox-Gastaut syndrome (n = 6), Lennox-Gastaut syndrome-like phenotype (n = 2), Landau-Kleffner syndrome (n = 1), epilepsy with myoclonic-atonic seizures (n = 1), and unclassified DEEs (n = 3). Sleep architecture was often fragmented by epileptiform discharges and seizures resulting in arousals (median arousal index: 29.0 per h, range: 5.1-65.3). Moderate-to-severe obstructive sleep apnea (OSA) was observed in seven patients (53.8%). Three patients (23.1%) had tonic seizures that frequently occurred with central apnea; one met criteria for mild central sleep apnea. Of the patients with tonic seizures, two had other identifiable seizure manifestations, but in one patient, central apnea was commonly the only discernable seizure manifestation. Polysomnography during video-EEG is an effective diagnostic tool in detecting sleep and seizure-related respiratory abnormalities. Clinically significant OSA may increase the risk of comorbid cardiovascular disease and premature mortality. Treatment of epilepsy may improve sleep quality, and conversely, improved sleep, may decrease seizure burden.
Topics: Female; Male; Humans; Polysomnography; Lennox Gastaut Syndrome; Sleep Apnea, Central; Sleep; Seizures; Electroencephalography; Sleep Apnea, Obstructive
PubMed: 37277988
DOI: 10.1002/epi4.12772 -
Arquivos de Neuro-psiquiatria Oct 2020
Topics: Humans; Polysomnography; REM Sleep Behavior Disorder; Sleep, REM
PubMed: 33146234
DOI: 10.1590/0004-282X20200189 -
Scientific Reports May 2022The adoption of multisensor wearables presents the opportunity of longitudinal monitoring of sleep in large populations. Personalized yet device-agnostic algorithms can...
The adoption of multisensor wearables presents the opportunity of longitudinal monitoring of sleep in large populations. Personalized yet device-agnostic algorithms can sidestep laborious human annotations and objectify cross-cohort comparisons. We developed and tested a heart rate-based algorithm that captures inter- and intra-individual sleep differences in free-living conditions and does not require human input. We evaluated it on four study cohorts using different research- and consumer-grade devices for over 2000 nights. Recording periods included both 24 h free-living and conventional lab-based night-only data. We compared our optimized method against polysomnography, sleep diaries and sleep periods produced through a state-of-the-art acceleration based method. Against sleep diaries, the algorithm yielded a mean squared error of 0.04-0.06 and a total sleep time (TST) deviation of [Formula: see text]2.70 (± 5.74) and 12.80 (± 3.89) minutes, respectively. When evaluated with PSG lab studies, the MSE ranged between 0.06 and 0.11 yielding a time deviation between [Formula: see text]29.07 and [Formula: see text]55.04 minutes. These results showcase the value of this open-source, device-agnostic algorithm for the reliable inference of sleep in free-living conditions and in the absence of annotations.
Topics: Heart Rate; Humans; Polysomnography; Reproducibility of Results; Sleep; Wearable Electronic Devices
PubMed: 35562527
DOI: 10.1038/s41598-022-11792-7 -
Medical & Biological Engineering &... Jun 2011Sleep medicine is a growing field with multidisciplinary origins in physiological monitoring techniques, on which it still largely depends. Collaborations between...
Sleep medicine is a growing field with multidisciplinary origins in physiological monitoring techniques, on which it still largely depends. Collaborations between engineers and sleep specialists offer substantial opportunities to improve on current approaches to diagnosis and assessment of patients with sleep problems. Such collaborations could also prove key to improved fundamental understanding of the pathophysiology that underlies sleep disorders and their adverse impact on the brain, cardiovascular system, and optimal health.
Topics: Humans; Polysomnography; Signal Processing, Computer-Assisted; Sleep Apnea, Obstructive; Sleep Wake Disorders
PubMed: 21487817
DOI: 10.1007/s11517-011-0777-4