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A Journal on Psychiatry, Psychology and Psychopharmacology
Official Journal of the Italian Society of Social Psychiatry
Indexed/Abstracted in: EMBASE, e-psyche, PsycINFO, Scopus, Emerging Sources Citation Index
Minerva Psichiatrica 2007 March;48(1):75-86
Instrumental diagnosis of obstructive sleep apnea syndrome in adults: in-lab polysomnography or portable monitoring devices?
Cirignotta F., Ferlisi M., Mondini S.
Unità Operativa di Neurologia Policlinico S. Orsola-Malpighi Azienda Ospedaliero-Universitaria di Bologna, Bologna
Diagnosis of obstructive sleep apnea syndrome (OSAS) requires instrumental assessment, traditionally based on in-laboratory overnight polysomnography, gold standard for diagnosis. It is an expensive, labor intensive test, and requires attendance by qualified technicians and suited equipment. Considering the high prevalence of this syndrome in general population and the increasing demands for clinical and instrumental tests, portable, less expensive diagnostic tools have been developed in last years. Most common ones are cardiorespiratory monitoring devices that do not require the patient to be studied in a sleep laboratory. According to American Academy of Sleep Medicine guidelines, these portable monitoring devices are not recommended in the evaluation of OSAS in the unattended setting: they may be an acceptable alternative in the absence of available polysomnography, but only in selected circumstances. Nevertheless, the unattended studies are widely used in clinical practice. The Italian Association of Sleep Medicine (Associazione Italiana di Medicina del Sonno, AIMS) and the Italian Association of Hospital Pneumologists (Associazione Italiana Pneumo-logi Ospedalieri, AIPO) proposed to admit portable monitoring devices in the unattended setting for the diagnosis of OSAS: in order to reduce wrong diagnosis, the type of instrumental test has to be selected on the basis of clinical data, with an algorithmic approach based upon symptoms and signs. The main point is that more severe are symptoms of patients (high-probability group for OSAS) more simple can be the instrumental test for diagnosis. Nevertheless, this model should be implemented and validated according to evidence-based criteria.