title: Portable monitors in the diagnosis of obstructive sleep apnea.
abstract: The use of portable monitors (PM) devices has been demonstrated in a wide variety of investigational settings with varying results. While most devices correlate very well with in-laboratory polysomnography, some still misclassify a significant numbers of patients and have lower sensitivity. In addition, the failure rate of PM devices is higher than that of in-laboratory polysomnography, requiring repeated investigations. Nonetheless, these devices may reduce the waiting time for diagnosis and could potentially decrease costs. Cost-effectiveness studies have yet to demonstrate an advantage to using PM devices, although their employed modeling techniques may not accurately reflect prevailing practices. The majority of third-party payers do not reimburse unattended studies and consider them still to be investigational. Some health maintenance organizations have begun to recognize PM-based studies in their diagnostic algorithms and will cover their cost; others may do so on a case-by-case basis. There continues to be a dearth of evidence to support widespread implementation of PM devices for use within the general population. Larger-scale validation studies in patients with lower pretest probabilities and a wide range of comorbidities are needed.
authors.affiliation: Division of Sleep Medicine, Department of Medicine, University of Pennsylvania School of Medicine, 3624 Market St, Suite 205, Philadelphia, PA 19104, USA. Murtuza.Ahmed@uphs.upenn.edu
authors.forename: Murtuza
authors.initials: M
authors.lastname: Ahmed
authors.forename: Nirav P
authors.initials: NP
authors.lastname: Patel
authors.forename: Ilene
authors.initials: I
authors.lastname: Rosen
mesh_terms: D003362:Cost-Benefit Analysis; D006801:Humans; D018670:Monitoring, Ambulatory / Q000295:instrumentation*; D017286:Polysomnography / Q000295:instrumentation*; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis*