portable Sleep Apnea Testing: An Update

RESUMELes appareils de depistage portatifs de l’apnee du sommeil ont subi une transformation au cours de la derniere decennie et sont devenus une methode de test de diagnostic des evenements respiratoires du sommeil credible, fiable et economique. Depuis leurs debuts en tant que canal unique d’oxymetrie pulsee jusqu’aux 8 a 12 appareils modernes a plusieurs canaux, les appareils de depistage portatifs des evenements respiratoires sont un important outil pour les fournisseurs de therapie du sommeil dans la collectivite ou les hopitaux. Dans le present article, nous examinons le processus de selection des patients afin de savoir s’ils sont aptes a se servir des appareils de depistage portatifs, l’appariement de l’appareil approprie au patient ainsi que le processus de deroulement du travail pour recueillir, examiner, coter et interpreter les donnees. Tout ce qui precede est effectue dans le cadre de directives de specialistes publiees recemment pour l’utilisation du depistage de l’apnee du sommeil a domicile. Le depistage de l’apnee du sommeil a domicile sans surveillance ne convient pas a tous les patients et on examine ici les criteres servant a determiner quels patients doivent etre diriges vers un polysomnogramme de niveau 1 sous surveillance dans un etablissement reconnu. On souligne le role du technologue du sommeil agree qui s’occupe du patient avant le test, examine les donnees telechargees et les cote en fonction des criteres de l’American Academy of Sleep Medicine (AASM). On aborde la responsabilite du medecin specialiste du sommeil consistant a interpreter les donnees adequatement a la lumiere des symptomes, des comorbidites medicales et du sommeil. Une attention particuliere est accordee aux appareils portables perfectionnes de depistage des apnees du sommeil qui detectent des reveils neurologiques (attribuables a des evenements respiratoires), a l’utilisation du telechargement des donnees en ligne, a la notation et a l’interpretation des portails et a la necessite de veiller a ce que le medecin traitant, le dentiste ou le fournisseur d’appareils respiratoires evaluent les donnees dans le contexte de la sante globale du sommeil du patient. INTRODUCTIONSleep is a necessary biological process that serves to conserve energy, restore and rejuvenate tissues and organs, consolidate memory, and provide a sense of refreshed well-being at the beginning of each day. Since the early 1950s, great strides have been made in establishing an understanding of the underlying physiological processes that serve to define and regulate sleep. With the advent of polysomnography, and more importantly, with the establishment of comprehensive combined sleep clinic/laboratories (such as the pioneering Stanford University clinic which opened in 1971 [1]), a much broader understanding of the pathology of sleep has ABSTRACTPortable sleep apnea testing has undergone a transformation in the past decade and has emerged as a credible, reliable, cost-effective diagnostic testing modality for sleep disordered breathing. From its beginnings as a single-channel overnight pulse oximetry test to the modern 8-12 (or more) multi-channel devices, portable testing for sleep disordered breathing is an important tool for both community and hospital-based sleep therapy providers. In this article, we review the patient selection process for suitability for portable sleep apnea testing; the matching of the appropriate device to the individual patient; and the workflow process for collecting, reviewing, scoring, and interpreting the data. All of this is done within the framework of recently published expert guidelines for the use of home sleep testing.Not all patients are suitable for unmonitored home-based sleep testing, and the criteria used to determine which of those should be referred for a monitored level 1 polysomnogram in an accredited sleep facility are reviewed. The role of the registered sleep technologist (RPSGT) in both in-servicing the patient prior to the test being performed, reviewing the downloaded data, and scoring to the American Academy of Sleep Medicine (AASM) criteria is highlighted. The responsibility of the sleep-trained physician to interpret the data appropriately in light of the patients’ symptoms, medical comorbidities, and sleep comorbidities is discussed.Special consideration is given to advanced portable sleep apnea testing devices that detect neurological arousals (due to respiratory events); the use of online data uploading; scoring and interpreting portals; and the necessity of ensuring that the referring physician, dentist, or continuous positive airway pressure (CPAP) provider assesses the data in the context of the comprehensive sleep health of the patient.