J Korean Med Assoc.  2012 Feb;55(2):138-145. 10.5124/jkma.2012.55.2.138.

Diagnostic aspects of polysomnography in obstructive sleep apnea

• Lee SH

• KMID: 2192662
• DOI: http://doi.org/10.5124/jkma.2012.55.2.138

Abstract

Obstructive sleep apnea (OSA) is a sleep-related breathing disorder which is characterized by intermittent hypoxia and frequent arousals because of partial or complete upper airway obstruction during sleep. This condition may be associated with various clinical sequelae such as hypertension, cardiovascular disorders, and metabolic syndrome in adults, and failure to thrive, deformity of dentofacial structures, behavioral problems, impairment of sleep-related quality of life, and enuresis in children. Although technician-attended, in-laboratory, overnight standard polysomnography (PSG) is considered a basic and important diagnostic test to classify the severity of respiratory disturbance and define the proper treatment modality in adults and children with OSA, it is too expensive and complicated to perform. Recently, in order to overcome the disadvantages of standard PSG in the clinical field, a portable sleep monitoring device has been introduced as an alternative to standard PSG in selected patients. The purpose of this article is to elucidate the clinical indications of polysomnography in OSA, to define the differential characteristics of polysomnographic indices between children and adults with OSA, and to introduce the clinical efficacy of a portable sleep monitoring device.

Keyword

Polysomnography; Adult; Child; Obstructive sleep apnea

MeSH Terms

Adult
Airway Obstruction
Anoxia
Arousal
Child
Congenital Abnormalities
Diagnostic Tests, Routine
Enuresis
Failure to Thrive
Humans
Hypertension
Polysomnography
Quality of Life
Respiration
Sleep Apnea, Obstructive

Reference

1. Kushida CA, Littner MR, Morgenthaler T, Alessi CA, Bailey D, Coleman J Jr, Friedman L, Hirshkowitz M, Kapen S, Kramer M, Lee-Chiong T, Loube DL, Owens J, Pancer JP, Wise M. Practice parameters for the indications for polysomnography and related procedures: an update for 2005. Sleep. 2005. 28:499–521.

2. Collop NA, Anderson WM, Boehlecke B, Claman D, Goldberg R, Gottlieb DJ, Hudgel D, Sateia M, Schwab R. Portable Monitoring Task Force of the American Academy of Sleep Medicine. Clinical guidelines for the use of unattended portable monitors in the diagnosis of obstructive sleep apnea in adult patients. Portable Monitoring Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med. 2007. 3:737–747.

3. Iber C, Ancoli-Israel S, Chesson AL Jr, Quan SF. The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications. 2007. Westchester: American Academy of Sleep Medicine.

4. Choi JH, Kim EJ, Choi J, Kwon SY, Kim TH, Lee SH, Lee HM, Shin C, Lee SH. Obstructive sleep apnea syndrome: a child is not just a small adult. Ann Otol Rhinol Laryngol. 2010. 119:656–661.

5. Aurora RN, Casey KR, Kristo D, Auerbach S, Bista SR, Chowdhuri S, Karippot A, Lamm C, Ramar K, Zak R, Morgenthaler TI. American Academy of Sleep Medicine. Practice parameters for the surgical modifications of the upper airway for obstructive sleep apnea in adults. Sleep. 2010. 33:1408–1413.

6. Kushida CA, Morgenthaler TI, Littner MR, Alessi CA, Bailey D, Coleman J Jr, Friedman L, Hirshkowitz M, Kapen S, Kramer M, Lee-Chiong T, Owens J, Pancer JP. American Academy of Sleep. Practice parameters for the treatment of snoring and obstructive sleep apnea with oral appliances: an update for 2005. Sleep. 2006. 29:240–243.

7. Mitchell RB, Pereira KD, Friedman NR. Sleep-disordered breathing in children: survey of current practice. Laryngoscope. 2006. 116:956–958.

8. Roland PS, Rosenfeld RM, Brooks LJ, Friedman NR, Jones J, Kim TW, Kuhar S, Mitchell RB, Seidman MD, Sheldon SH, Jones S, Robertson P. American Academy of Otolaryngology-Head and Neck Surgery Foundation. Clinical practice guideline: Polysomnography for sleep-disordered breathing prior to tonsillectomy in children. Otolaryngol Head Neck Surg. 2011. 145:1 Suppl. S1–S15.

9. Ferber R, Millman R, Coppola M, Fleetham J, Murray CF, Iber C, McCall V, Nino-Murcia G, Pressman M, Sanders M. Portable recording in the assessment of obstructive sleep apnea. ASDA standards of practice. Sleep. 1994. 17:378–392.

10. Flemons WW, Whitelaw WA, Brant R, Remmers JE. Likelihood ratios for a sleep apnea clinical prediction rule. Am J Respir Crit Care Med. 1994. 150(5 Pt 1):1279–1285.

11. Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991. 14:540–545.

12. Morgenthaler TI, Aurora RN, Brown T, Zak R, Alessi C, Boehlecke B, Chesson AL Jr, Friedman L, Kapur V, Maganti R, Owens J, Pancer J, Swick TJ. Standards of Practice Committee of the AASM. American Academy of Sleep Medicine. Practice parameters for the use of autotitrating continuous positive airway pressure devices for titrating pressures and treating adult patients with obstructive sleep apnea syndrome: an update for 2007. An American Academy of Sleep Medicine report. Sleep. 2008. 31:141–147.

13. Ayas NT, Patel SR, Malhotra A, Schulzer M, Malhotra M, Jung D, Fleetham J, White DP. Auto-titrating versus standard continuous positive airway pressure for the treatment of obstructive sleep apnea: results of a meta-analysis. Sleep. 2004. 27:249–253.

14. Lloberes P, Ballester E, Montserrat JM, Botifoll E, Ramirez A, Reolid A, Gistau C, Rodriguez-Roisin R. Comparison of manual and automatic CPAP titration in patients with sleep apnea/hypopnea syndrome. Am J Respir Crit Care Med. 1996. 154(6 Pt 1):1755–1758.