Effectiveness Of Portable Monitoring Devices For Diagnosing Obstructive Sleep Apnea
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Effectiveness Of Portable Monitoring Devices For Diagnosing Obstructive Sleep Apnea
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Author : Linda J. Lux
language : en
Publisher:
Release Date : 2004
Effectiveness Of Portable Monitoring Devices For Diagnosing Obstructive Sleep Apnea written by Linda J. Lux and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2004 with categories.
CONTEXT: Obstructive sleep apnea (OSA) is a serious public health problem. Approximately 2 percent to 4 percent of middle-aged women and men, respectively, have this condition; the majority are undiagnosed. Undiagnosed and thus untreated, OSA is associated with significant morbidity and mortality. Effective treatment modalities should not be applied without an accurate diagnosis of OSA, but medical history and physical examination are insufficient to establish the diagnosis or its severity. Using the accepted reference standard test - attended, in-laboratory polysomnography (PSG) - can be expensive and involve long waiting times for studies, so various groups have developed portable technologies to classify patients in terms of the presence or absence of OSA and, for the former, level of severity. Such devices are intended for use in sleep laboratories or in the home. OBJECTIVES: We updated a 2002-2003 systematic review of OSA diagnostic testing to address the key questions of how portable sleep testing devices compared to PSG in diagnosing OSA and, assuming equivalent effectiveness, what sleep and physiologic factors and what patient and technician conditions were important to measure or have in place. The Centers for Medicare and Medicaid Services commissioned the Agency for Healthcare Research and Quality to provide a technology assessment that addressed the following: 1. How does the diagnostic test performance of unattended portable multi-channel home sleep testing compare to facility-based polysomnography in the diagnosis of obstructive sleep apnea?1.1. If unattended portable multi-channel home sleep testing is as effective as polysomnography in the diagnosis of obstructive sleep apnea, which parameters of sleep and cardiorespiratory function (i.e., sleep staging, body position, limb movements, respiratory effort, airflow, oxygen saturation, electrocardiogram) are required?1.2. If unattended portable multi-channel home sleep testing is as effective as polysomnography in the diagnosis of obstructive sleep apnea, what conditions (i.e., patient education, technician support) are required so that it is done correctly in the home? DATA SOURCES: We searched for studies published since the original review (i.e., from 2002 on) in MEDLINE, The Cochrane Library, the National Guidelines Clearinghouse, and the International Network of Agencies for Health Technologies Assessment (INAHTA) database; we also handsearched bibliographies of included articles. In MEDLINE, we used the following main terms in various combinations: polysomnography, oximetry, physiologic monitoring, and sleep apnea (with limits of human, adults, and English language); we refined searches using the terms airway resistance, upper airway resistance syndrome, respiratory disturbance index, autoset, snoring, and respiratory events related arousals as well as reproducibility of results, predictive value of tests, and sensitivity and specificity. STUDY SELECTION: We included studies of humans, both sexes, ages 18 and over, with any diagnosis of OSA; studies of any type of portable device used for diagnosis that also included a reference standard test (PSG or another acceptable test for diagnosing OSA); studies in which each analysis group, after the end of the study, included at least 10 subjects; and studies published in English. Specifically excluded were studies in which results from portable devices were not compared with results from PSG. Also excluded were reviews, meta-analyses, case reports, abstracts, letters, and editorials. DATA EXTRACTION: One investigator recorded abstracted data onto data abstraction forms used for the original review and created detailed evidence tables. A second investigator checked entries against the original articles. One investigator assigned initial classifications for level of evidence and presence or absence of eight quality indicators and a second investigator reviewed these; disagreements were resolved by consensus discussion. A third investigator combined level of evidence and quality indicators into a summary quality grade; the other investigators reviewed these grades, with differences resolved by consensus. DATA SYNTHESIS: We identified 172 unique titles and abstracts from the literature searches, and excluded 157 articles as not meeting inclusion criteria; reasons included the fact that PSG studies were not performed on all patients, that the portable device was an electroencephalogram (EEG), and that the study assessed a telemedicine approach that did not compare a portable device to the PSG. We obtained 15 articles for full review and retained 12 for inclusion here. These 12 studies fell into four categories: Type 3 devices used in laboratory settings (four studies); Type 3 devices tested in homes whether or not they were also tested in facilities (two studies); Type 4 devices in laboratory settings (six studies); and Type 4 devices tested in homes (whether or not in facilities, three studies). Type 3 devices include a minimum of four channels and must monitor at least two channels of respiratory movement or respiratory movement and airflow, and heart rate or ECG and oxygen saturation to define an event; generally, no electroencephalogram (EEG) signals are monitored. Level 4 devices include only one or two channels of physiologic signals and generally use only one channel (either saturated oxygen or airflow) to define a sleep-disordered breathing event; no EEG signals are monitored. Most articles provided only comparisons of the results from portable monitoring done simultaneously with full PSG in the laboratory, i.e., "a side-by-side" study. The in-laboratory simultaneous studies, which used technologies identical or similar to those in the previous review, produced sensitivity and specificity results for diagnosing OSA similar to those reported earlier; that is, the newer studies produced no meaningful changes in the level or quality of evidence for the effectiveness for home monitoring devices in diagnosing OSA. Only four of these studies (two of Type 3 and two of Type 4 devices) were graded good or fair quality. Ultimately, we focused on the five studies with in-home testing, because the questions we were asked concerned the effectiveness of unattended monitoring in the home. Four in-home studies employed technologies similar or identical to those reviewed before; of these, two studies (one of good quality, one poor) used Type 3 devices and two (one of fair quality , one poor) used Type 4 devices. Reported sensitivity and specificity values were similar to those from older studies, so the newer studies yielded no major information that would change the previous basic conclusions about portable devices used in the home. The one in-home study using a new technology, of fair quality, produced likelihood ratios that indicated that the test had little effect in changing pretest probabilities of the presence or absence of OSA. Reported data loss in the home studies ranged from a low of 3 percent to a high of 33 percent, in a subgroup of patients who did their own hookup. Automated scoring appeared to agree less closely with the reference standard than manual scoring. Internal validity of the five in-home studies was mixed: one study of good quality, two of fair quality, and two of poor quality. In terms of external validity, the patient populations were mostly male, middle-aged, and with high pretest probabilities of OSA; comorbidities were generally not specified or taken into account in analyses. Finally, these studies typically did not evaluate the accuracy of clinical management decisions based on portable results compared to those based on the reference standard. CONCLUSIONS: This newer body of evidence does not materially change earlier findings regarding in-home devices for diagnosing OSA. Choices of cutoffs for determining OSA by AHI or RDI differed widely across these studies, making cross-study comparisons impossible. The better studies yielded sensitivity and specificity values (or LRs) that provided modes changes in the probability of OSA over the pretest probability. In studies that directly compared automated versus manual scoring from home monitoring devices, manual scoring correlated better with data from laboratory PSG than did automated scoring.
Portable Monitoring Devices For Diagnosis Of Obstructive Sleep Apnea At Home
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Author : Sarah Ndegwa
language : en
Publisher:
Release Date : 2009
Portable Monitoring Devices For Diagnosis Of Obstructive Sleep Apnea At Home written by Sarah Ndegwa and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2009 with Health insurance continuation coverage categories.
The Rational Clinical Examination Evidence Based Clinical Diagnosis
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Author : David Simel
language : en
Publisher: McGraw Hill Professional
Release Date : 2008-04-30
The Rational Clinical Examination Evidence Based Clinical Diagnosis written by David Simel and has been published by McGraw Hill Professional this book supported file pdf, txt, epub, kindle and other format this book has been release on 2008-04-30 with Medical categories.
The ultimate guide to the evidence-based clinical encounter "This book is an excellent source of supported evidence that provides useful and clinically relevant information for the busy practitioner, student, resident, or educator who wants to hone skills of physical diagnosis. It provides a tool to improve patient care by using the history and physical examination items that have the most reliability and efficiency."--Annals of Internal Medicine "The evidence-based examination techniques put forth by Rational Clinical Examination is the sort that can be brought to bear on a daily basis – to save time, increase confidence in medical decisions, and help decrease unnecessary testing for conditions that do not require absolute diagnostic certainty. In the end, the whole of this book is greater than its parts and can serve as a worthy companion to a traditional manual of physical examination."--Baylor University Medical Center (BUMC)Proceedings 5 STAR DOODY'S REVIEW! "Physical diagnosis has been taught to every medical student but this evidence-based approach now shows us why, presenting one of medicine's most basic tenets in a new and challenging light. The format is extraordinary, taking previously published material and updating the pertinent evidence since the initial publication, affirming or questioning or refining the conclusions drawn from the data. "This is a book for everyone who has studied medicine and found themselves doubting what they have been taught over the years, not that they have been deluded, but that medical traditions have been unquestionably believed because there was no evidence to believe otherwise. The authors have uncovered the truth. "This extraordinary, one-of-a-kind book is a valuable addition to every medical library."--Doody's Review Service Completely updated with new literature analyses, here is a uniquely practical, clinically relevant approach to the use of evidence in the content of physical examination. Going far beyond the scope of traditional physical examination texts, this invaluable resource compiles and presents the evidence-based meanings of signs, symptoms, and results from physical examination maneuvers and other diagnostic studies. Page after page, you'll find a focus on actual clinical questions and presentations, making it an incomparably practical resource that you'll turn to again and again. Importantly, the high-yield content of The Rational Clinical Examination is significantly expanded and updated from the original JAMA articles, much of it published here for the first time. It all adds up to a definitive, ready-to-use clinical exam sourcebook that no student or clinician should be without. FEATURES Packed with updated, new, and previously unpublished information from the original JAMA articles Standardized template for every issue covered, including: Case Presentation; Why the Issue Is Clinically Important; Research and Statistical Methods Used to Find the Evidence Presented; The Sensitivity and Specificity of Each Key Result; Resolution of the Case Presentation; and the Clinical Bottom Line Completely updated with all-new literature searches and appraisals supplementing each chapter Full-color format with dynamic clinical illustrations and images Real-world focus on a specific clinical question in each chapter, reflecting the way clinicians approach the practice of evidence-based medicine More than 50 complete chapters on common and challenging clinical questions and patient presentations Also available: JAMAevidence.com, a new interactive database for the best practice of evidence based medicine
Sleep Disorders And Sleep Deprivation
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Author : Institute of Medicine
language : en
Publisher: National Academies Press
Release Date : 2006-10-13
Sleep Disorders And Sleep Deprivation written by Institute of Medicine and has been published by National Academies Press this book supported file pdf, txt, epub, kindle and other format this book has been release on 2006-10-13 with Medical categories.
Clinical practice related to sleep problems and sleep disorders has been expanding rapidly in the last few years, but scientific research is not keeping pace. Sleep apnea, insomnia, and restless legs syndrome are three examples of very common disorders for which we have little biological information. This new book cuts across a variety of medical disciplines such as neurology, pulmonology, pediatrics, internal medicine, psychiatry, psychology, otolaryngology, and nursing, as well as other medical practices with an interest in the management of sleep pathology. This area of research is not limited to very young and old patientsâ€"sleep disorders reach across all ages and ethnicities. Sleep Disorders and Sleep Deprivation presents a structured analysis that explores the following: Improving awareness among the general public and health care professionals. Increasing investment in interdisciplinary somnology and sleep medicine research training and mentoring activities. Validating and developing new and existing technologies for diagnosis and treatment. This book will be of interest to those looking to learn more about the enormous public health burden of sleep disorders and sleep deprivation and the strikingly limited capacity of the health care enterprise to identify and treat the majority of individuals suffering from sleep problems.
Obstructive Sleep Apnea In Adults
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Author : J.S. Borer
language : en
Publisher: Karger Medical and Scientific Publishers
Release Date : 2011-09-14
Obstructive Sleep Apnea In Adults written by J.S. Borer and has been published by Karger Medical and Scientific Publishers this book supported file pdf, txt, epub, kindle and other format this book has been release on 2011-09-14 with Health & Fitness categories.
This book aims to provide a comprehensive and clear review of the current knowledge of the relationship between obstructive sleep apnea (OSA) and cardiovascular and metabolic diseases, a subject of concern to a wide range of specialists and general practitioners. Separate chapters describe: the definition, symptoms and sequelae of OSA, and the diagnostic strategies and treatment options for adults with OSA according to the American Academy of Sleep Medicine; pathogenic mechanisms, by which OSA may contribute to the development and progression of cardiovascular and metabolic disorders, including inflammation, oxidative stress and thrombosis; links between OSA and obesity, alterations in glucose metabolism, metabolic syndrome and liver injury; relationships between OSA, endothelial dysfunction, autonomic dysfunction and cardiovascular disorders, and the results of studies investigating the effect of treatment for OSA on the concomitant cardiovascular disease. Each chapter summarizes the essential information and is illustrated by tables and figures, which will aid the readers in their understanding of the complex systemic interactions involved in this disease.Reviewed by internationally recognized experts, this publication will be of benefit to clinicians and scientists in the fields of pulmonology, cardiology, endocrinology and neurology as well as to sleep specialists and general practitioners.
Sleep Disordered Breathing In Children
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Author : Leila Kheirandish-Gozal
language : en
Publisher: Springer Science & Business Media
Release Date : 2012-07-17
Sleep Disordered Breathing In Children written by Leila Kheirandish-Gozal and has been published by Springer Science & Business Media this book supported file pdf, txt, epub, kindle and other format this book has been release on 2012-07-17 with Medical categories.
Sleep Disordered Breathing in Children: A Comprehensive Clinical Guide to Evaluation and Treatment is a comprehensive, timely and up-to-date review of pediatric sleep disordered breathing (SDB) and offers a thorough focus on several key areas: namely, the normal development and maturation of the airway and breathing during sleep, the techniques that are in place for assessment of SDB in children, the clinical manifestations and characteristics of several pediatric populations at risk for SDB, the implications of SDB in various end-organ systems, and, finally, a critical review of the evidence on current therapeutic approaches. This unique and complete text is of welcome interest to all practicing physicians and healthcare professionals who evaluate children with sleep problems -- namely pulmonologists, pediatricians, sleep physicians, pediatric neurologists, pediatric otolaryngologists, and family practitioners, as well as clinical researchers, pediatric nurse practitioners and respiratory therapists. Written by a distinguished and international panel of authors who are renowned experts in their field and who offer an expanded view of the problems associated with SDB, Sleep Disordered Breathing in Children: A Comprehensive Clinical Guide to Evaluation and Treatment is an indispensible resource for all physicians who evaluate children for sleep-disordered breathing.
Home Portable Monitoring For Obstructive Sleep Apnea An Issue Of Sleep Medicine Clinics
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Author : Michael R. Littner
language : en
Publisher: Saunders
Release Date : 2011
Home Portable Monitoring For Obstructive Sleep Apnea An Issue Of Sleep Medicine Clinics written by Michael R. Littner and has been published by Saunders this book supported file pdf, txt, epub, kindle and other format this book has been release on 2011 with Medical categories.
Portable Sleep monitoring is a very important method of diagnosis and follow-up for sleep-disordered breathing. This state-of-the-art issue reviews the most recent information on classification, technical specifications and types of portable monitors, use and limitations of portable monitoring with integration into positive airway pressure treatment. use of portable monitors in children and in patients with oral appliances. Use of portable monitoring for SDB treatment with upper airway surgery is also discussed. Current published standards incliding CMS requirements for portable monitoring are reviewed. Outcome measures, illustrative cases, and a comparison with polysomnogram are included. Finally, future directions are discussed.
Sleep Apnea
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Author : Mayank Vats
language : en
Publisher: BoD – Books on Demand
Release Date : 2017-04-05
Sleep Apnea written by Mayank Vats and has been published by BoD – Books on Demand this book supported file pdf, txt, epub, kindle and other format this book has been release on 2017-04-05 with Medical categories.
Sleep medicine is developing rapidly with more than 100 sleep disorders discovered till now. Despite that, sleep specialty is in neonatal stage especially in developing and underdeveloped countries. Sleep medicine is still evolving with ongoing worldwide clinical research, training programs, and changes in the insurance policy disseminating more awareness in physicians and patients. Sleep apnea is one of the most common sleep disorders, found in around 5-7 % of the general population with high prevalence in the obese, elderly individuals but largely unrecognized and hence undiagnosed with untreated and life-threatening consequences. In the last decade, new complex sleep disorders and their pathophysiology have been discovered, new treatment options (pharmacological and nonpharmacological) are available, and hence we planned a book on the recent developments on the most common sleep disorder, sleep apnea. We have incorporated chapters from the eminent clinicians and authors around the globe to produce a state-of-the-art book with the target audience from internal medicine, pulmonary, sleep medicine, neurology, ENT, and psychiatry discipline.
Drug Induced Sleep Endoscopy
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Author : Nico de Vries
language : en
Publisher: Thieme
Release Date : 2020-11-11
Drug Induced Sleep Endoscopy written by Nico de Vries and has been published by Thieme this book supported file pdf, txt, epub, kindle and other format this book has been release on 2020-11-11 with Medical categories.
The definitive resource on the innovative use of DISE for obstructive sleep apnea Obstructive sleep apnea is the most prevalent sleep-related breathing disorder, impacting an estimated 1.36 billion people worldwide. In the past, OSA was almost exclusively treated with Continuous Positive Airway Pressure (CPAP), however, dynamic assessment of upper airway obstruction with Drug-Induced Sleep Endoscopy (DISE) has been instrumental in developing efficacious alternatives. Drug-Induced Sleep Endoscopy: Diagnostic and Therapeutic Applications by Nico de Vries, Ottavio Piccin, Olivier Vanderveken, and Claudio Vicini is the first textbook on DISE written by world-renowned sleep medicine pioneers. Twenty-four chapters feature contributions from an impressive group of multidisciplinary international experts. Foundational chapters encompass indications, contraindications, informed consent, organization and logistics, patient preparation, and drugs used in DISE. Subsequent chapters focus on treatment outcomes, the role of DISE in therapeutic decision making and upper airway stimulation, pediatric sleep endoscopy, craniofacial syndromes, advanced techniques, and more. Key Highlights Comprehensive video library highlights common and rare DISE findings A full spectrum of sleep disordered breathing and OSA topics, from historic to future perspectives Insightful clinical pearls on preventing errors and managing complications including concentric and epiglottis collapse Discussion of controversial DISE applications including oral appliances and positional and combination therapies This unique book is essential reading for otolaryngology residents, fellows, and surgeons. Clinicians in other specialties involved in sleep medicine will also benefit from this reference, including pulmonologists, neurologists, neurophysiologists, maxillofacial surgeons, and anesthesiologists.
Chalk Talks In Internal Medicine
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Author : Somnath Mookherjee
language : en
Publisher: Springer Nature
Release Date : 2020-09-30
Chalk Talks In Internal Medicine written by Somnath Mookherjee and has been published by Springer Nature this book supported file pdf, txt, epub, kindle and other format this book has been release on 2020-09-30 with Education categories.
This book provides teaching scripts for medical educators in internal medicine and coaches them in creating their own teaching scripts. Every year, thousands of attending internists are asked to train the next generation of physicians to master a growing body of knowledge. Formal teaching time has become increasingly limited due to rising clinical workload, medical documentation requirements, duty hour restrictions, and other time pressures. In addition, today’s physicians-in-training expect teaching sessions that deliver focused, evidence-based content that is integrated into clinical workflow. In keeping with both time pressures and trainee expectations, academic internists must be prepared to effectively and efficiently teach important diagnostic and management concepts. A teaching script is a methodical and structured plan that aids in effective teaching. The teaching scripts in this book anticipate learners’ misconceptions, highlight a limited number of teaching points, provide evidence to support the teaching points, use strategies to engage the learners, and provide a cognitive scaffold for teaching the topic that the teacher can refine over time. All divisions of internal medicine (e.g. cardiology, rheumatology, and gastroenterology) are covered and a section on undifferentiated symptom-based presentations (e.g. fatigue, fever, and unintentional weight loss) is included. This book provides well-constructed teaching scripts for commonly encountered clinical scenarios, is authored by experienced academic internists and allows the reader to either implement them directly or modify them for their own use. Each teaching script is designed to be taught in 10-15 minutes, but can be easily adjusted by the reader for longer or shorter talks. Teaching Scripts in Internal Medicine is an ideal tool for internal medicine attending physicians and trainees, as well as physician’s assistants, nurse practitioners, and all others who teach and learn internal medicine.