Sleep laboratory testing. The important facts.
To test a diagnostic tool's cost effectiveness, timeliness, and accuracy, one must focus on basic information. Merely examining the end results without regard for operating characteristics creates problems for the practitioner and patient alike. If the tool is capable of diagnosing only some of the patients studied, with the disturbing possibility that patients whose diagnoses are missed will not receive care, the practitioner should look elsewhere for a diagnostic tool that performs with greater accuracy despite the additional cost. As the demand for sleep diagnostic testing increases, accuracy and efficiency of diagnostic modalities becomes increasingly important. An alternative tool to standard attended polysomnography would be desirable but is probably unlikely. The results of missing a diagnosis or of mismanaging a patient with SDB can be serious indeed. The practitioner should thoroughly assess the patient and order the appropriate diagnostic study that will provide information that gives the patient the best opportunity for a desirable outcome. Sleepy patients are counting on practitioners everywhere to help them by using all the tools available. Countless mothers driving with children on the roads with these sleepy individuals are counting on the practitioner as well. Therefore, it behooves everyone who manages or wants to manage patients with SDB to offer uncompromising care to the patient with minimal regard to the health insurance industry's cost-cutting strategies. Dentists are and should be an integral part of the team caring for a patient with SDB. As part of the team, the dentist must know what tests to order and why to order them. As a referrer, whether to an otolaryngologist, allergist, pulmonologist, neurologist, or sleep center, the dentist is critical in the early detection of a prevalent nocturnal breathing problem. Many patients will present with early warning signs before related comorbidities develop that are potentially fatal to the patient and to health care economics. As part of the treatment and management team of the patient with SDB, dentists have the opportunity to intervene on their behalf before the disorder worsens. The proper diagnostic tools, when understood and used, will facilitate patient care, minimize risk, and decrease the long-term costs associated with mismanagement or improper diagnosis.
Dukes
P
P
Alpha Sleep Diagnostic Centers, Aurora, Colorado, USA. phil@denversleep.com
D003362:Cost-Benefit Analysis; D006801:Humans; D008511:Medicine; D010092:Oximetry; D010609:Pharyngeal Muscles / Q000503:physiopathology; D017286:Polysomnography / Q000191:economics / Q000379:methods; D015203:Reproducibility of Results; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis*; D013038:Specialization; D011795:Surveys and Questionnaires; D013997:Time Factors