Diagnostic Strategies

With the high prevalence of obstructive sleep apnea, there has been an ongoing debate on what constitutes the “best test” to make the diagnosis of the condition. Diagnostic strategies can now be based on pretest clinical suspicion. Patients assigned to a high-suspicion group because of habitual loud snoring, excessive daytime sleepiness, moderate to severe obesity, and observed apneas during sleep can potentially be diagnosed by either in-laboratory full polysomnography or a cardiopulmonary recording device at home. Patients with possible sleep apnea who do not fit into the high-probability group would be best served in a laboratory setting with full polysomnography using specialized monitoring devices to assess airflow limitation. Patients who present with a chief complaint of daytime sleepiness and a low chance of having sleep apnea might have periodic limb movements during sleep or narcolepsy. These patients would need full polysomnography in a sleep center potentially with a multiple sleep latency test the next day. Key Words: polysomnography - cardiopulmonary recordings - upper airway resistance syndrome