Practice parameters for the indications for polysomnography and related procedures: an update for 2005.
Practice parameters for the indications for polysomnography and related procedures: an update for 2005.
American Academy of Sleep Medicine - Professional Association
Summary,
GUIDELINE OBJECTIVE(S)
To reissue, modify and, if necessary, replace recommendations for indications for polysomnography (PSG) and related procedures based on the scientific literature published since 1997
TARGET POPULATION
Patients suspected of having sleep related breathing disorders (SRBD), other respiratory disorders, narcolepsy, parasomnias and sleep related seizure disorders, restless legs syndrome and periodic limb movement sleep disorder, depression with insomnia, or circadian rhythm sleep disorders
Note: These recommendations mainly pertain to adults, since the indications for polysomnography (PSG) in the diagnosis of sleep disorders in pediatric patients may be different. Nevertheless, the recommendations for some sleep disorders, such as parasomnias and sleep related seizure disorders, are applicable to adult, adolescent, and pediatric patients.
INTERVENTIONS AND PRACTICES CONSIDERED
1. Sleep history and physical examination
* Snoring, sleepiness, obesity, witnessed apneas
* Clinical prediction models
* Heart disease
2. Use of portable monitoring devices
3. Polysomnography (attended), including:
* Electroencephalography (EEG)
* Electroculography (EOG)
* Electromyography (EMG) at chin, anterior tibialis or extensor digitorum
* Airflow
* Arterial oxygen saturation
* Respiratory effort
* Electrocardiography
* Heart rate
4. Continuous positive airway pressure (CPAP) titration, bi-level PAP, and auto-titrating PAP
5. Cardiorespiratory sleep studies (attended and unattended)
6. Multiple sleep latency test
7. Oximetry
8. Pulmonary function tests
9. Arterial blood gases
10. Ferritin level, complete blood count, urinalysis, and screening chemistries (restless legs syndrome)
11. Psychiatric evaluation
12. Actigraphy
13. Evaluation of sleep diaries
14. Serum and urinary melatonin levels and twenty-four hour core body temperature levels
MAJOR OUTCOMES CONSIDERED
* Prevalence of sleep related breathing disorders (SRBDs)
* Effectiveness of polysomnography (PSG) in diagnosing SRBDs
* Effectiveness of PSG in evaluation or diagnosis of patients with sleep-related symptoms (e.g., suspected narcolepsy, parasomias, neuromusulcar disorders, sleep disruptions, seizure disorders)
