ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Portable vs. In-Lab Diagnosis of Obstructive Sleep Disorder For the Frail Elder Patient
Clinical Question For non-mobile frail elder patients with co-morbidities that may include cardiac, pulmonary and endocrine issues, is the home sleep test as accurate as the Nocturnal Polysomnography in diagnosing mild to moderate obstructive sleep disorder?
Clinical Bottom Line Home study diagnostic tests are comparable to lab-based polysomnography for reliability in diagnosing obstructive sleep apnea. The home study diagnostics are lower in cost and wait time, and less intrusive to an elder patient's lifestyle. (See Comments on the CAT below)
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 16735890Ghegan/2006Prospective cohort studies of portable and in-laboratory sleep studies performed on the same groups of patients. A total of 18 papers were identified in two independent Medline searches.Meta-Analysis
Key resultsThis was the only study that was found that addressed the question as stated. Home sleep studies are similar diagnostically to laboratory polysomnograms in the evaluation of sleep-disordered breathing. However, it was reported home sleep studies may underestimate the severity sleep apnea. Home sleep studies are viable screening tools for patients with suspected OSA due to lower costs and short wait times.
Evidence Search (("sleep apnea, obstructive"[MeSH Terms] OR ("sleep"[All Fields] AND "apnea"[All Fields] AND "obstructive"[All Fields]) OR "obstructive sleep apnea"[All Fields] OR ("sleep"[All Fields] AND "apnea"[All Fields] AND "obstructive"[All Fields]) OR "sleep apnea, obstructive"[All Fields]) AND home[All Fields] AND ("polysomnography"[MeSH Terms] OR "polysomnography"[All Fields] OR ("sleep"[All Fields] AND "test"[All Fields]) OR "sleep test"[All Fields])) OR (Nocturnal[All Fields] AND ("polysomnography"[MeSH Terms] OR "polysomnography"[All Fields])) AND Meta-Analysis[ptyp]
Comments on
The Evidence
A single Meta Analysis was found. Validity: This Meta-Analysis restricted its review to: 1) prospective cohort studies that performed both the portable and in-laboratory sleep studies (gold-standard for diagnosis) either simultaneously or in sequential fashion in the same group of patients and 2) provides information on at least one outcome: RDI, mean low O2 saturation, recorded sleep time quality of sleep, study cost, for each diagnostic method. Final analysis was made on those studies that allowed comparison of RDI, Low O2 saturation, sleep time, rate of inadequate recording, and cost. Perspective: Portable home sleep study devices provide similar diagnostic information to in-laboratory polysomnography (PSG) in the evaluation of sleep-disordered breathing. Portable devices are beneficial due to reduced cost and wait time. While they are similar to PSG in sensitivity with regards to the measure of mean low O2 saturation, recorded sleep time, sleep quality the portable units had significantly lower RDI readings than PSG, 10% on average. Due to these differences, the portable devices may underestimate apnea severity. While the portable device may underestimate the severity of sleep apnea it would serve as an appropriate screening too for those suspected to have obstructive sleep disorders.
Applicability Because a home sleep study is deemed equivalent to the laboratory based polysomnography for an initial diagnosis of obstructive sleep apnea, it can be a viable alternative for the elder, non-mobile patient. Home sleep study results are recordable and more readily available to the elder at a lower cost and less wait time than the laboratory based polysomnography. All these factors imply increased compliance to testing and thus increased diagnosis to guide intervention. Since this meta-analysis does not specifically address the frail elder as a seperate population, these result should be applied with caution.
Specialty/Discipline (Oral Medicine/Pathology/Radiology) (General Dentistry)
Keywords sleep apnea, obstructive, nocturnal polysomnography, sleep test, geriatric, frail elder
ID# 2345
Date of submission: 03/15/2013spacer
E-mail Taverna@UTHSCSA.edu
Author Melanie Taverna, RDH
Co-author(s) Ellis Shwarts
Co-author(s) e-mail Shwarts@livemail.uthscsa.edu
Faculty mentor/Co-author
Faculty mentor/Co-author e-mail
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
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Comments on the CAT
(FOR PRACTICING DENTISTS' and/or FACULTY COMMENTS ON PUBLISHED CATs)
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by Alexander Ling (San Antonio, TX) on 05/29/2013
In a multi-site randomized trial (PMID: 22654195 ) that can serve to expand on the findings found by Ghegan's group here, a comparison of home-based positive airway pressure auto-titrating device (autoPAP) versus laboratory-based polysomnography (PSG) with continuous positive airway pressure (CPAP) titration was performed. Observing 373 patients aged 18 years or older, with an apnea-hyponea index of at least 15 and Epiworth sleepiness scale of at least 12 at seven American Academy of Sleep Medicine accredited sleep centers, the following measurements were taken: CPAP acceptance, time-to-treatment, adherence at 1 and 3 months, changes in the Epworth Sleepiness Scale, as well as functional outcomes. It was found that a home-based strategy was not inferior when compared to the in-laboratory PSG in terms of acceptance, adherence, time to treatment, and functional improvements; these findings very closely mirror the clinical bottom line of this CAT. However, it must be noted that the patient selection criteria are not restricted to only elderly patients, but all patients over the age of 18 who match the inclusion requirements.
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