When it comes to testing for and monitoring of obstructive sleep apnea, portable sleep monitors are an excellent means of avoiding difficult overnight stays in sleep labs. Testing in sleep labs can cause problems due to non-ideal conditions, and consequently can create non-ideal results in testing.
New guidelines published in the Annals of Internal Medicine which are based on several decades of evidence suggest that these monitors are as effective as sleep clinic monitoring.
Sleep apnea is a serious condition that results in far more than sleepiness and lethargy during the day. While there is no evidence of direct causation, the condition can be related to a far more severe risk of such conditions as heart attack, diabetes, stroke and cognitive difficulties. Currently, nine out of ten people who suffer from sleep apnea have not been diagnosed.
Diagnosing the Condition
There are two basic ways to diagnose obstructive sleep apnea, which can cause people to stop breathing during the night while they sleep and can even result in death in severe cases.
The first means of diagnosis is the sleep clinic, where the patient is monitored overnight while they sleep. The second is to set up the patient with a portable sleep monitor which they can take home with them.
The new guidelines offer the recommendation that if a person finds that they suffer from unexplained tiredness, lethargy, difficulty with focus or other cognitive issues during their normal day, they should undergo testing and sleep studies either at a lab or using a portable monitor.
Portable Monitors on the Rise
Home sleep study tests use portable monitors that are becoming much more common, and their use has increased greatly over the past few years. Insurance companies prefer patients to use the portable sleep monitors as the cost is significantly less than a stay at a sleep clinic. These sleep monitors tend to be just as accurate as those obtained from laboratory tests.
Currently, portable sleep monitors cost less than $300 to obtain and use while studies at a sleep clinic can range to well over $1,000. The difference is that portable sleep monitors don’t require a technician to set up and monitor testing, or the cost of overhead from the use of a sleep clinic facility.
Limitations of Home Monitoring
While at home sleep studies are a great option for many patients, they don’t provide as much data as studies conducted in a sleep lab. A sleep lab can monitor your brain waves and leg movements, for example, which can provide valuable data to help diagnose additional sleep disorders.
It is also important to note that those patients with conditions such as chronic lung disease, congestive heart failure and certain neurological conditions should not use a portable monitor. Their conditions can be serious enough that the use of a portable monitor can create complications.
In addition, roughly 20% of patients find that the monitors don’t actually provide an adequate diagnosis and may miss diagnosis altogether if the condition if very mild.
This doesn’t mean that patients shouldn’t use the home monitors, just that they should be aware there are limitations; these are laid out in the new guidelines.
By Ramie A Tritt, MD, President, Atlanta ENT