Collop Nancy A, Anderson W McDowell, Boehlecke Brian, Claman David, Goldberg Rochelle, Gottlieb Daniel J, Hudgel David, Sateia Michael, Schwab Richard
Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD 21205, USA.
J Clin Sleep Med. 2007 Dec 15;3(7):737-47.
Based on a review of literature and consensus, the Portable Monitoring Task Force of the American Academy of Sleep Medicine (AASM) makes the following recommendations: unattended portable monitoring (PM) for the diagnosis of obstructive sleep apnea (OSA) should be performed only in conjunction with a comprehensive sleep evaluation. Clinical sleep evaluations using PM must be supervised by a practitioner with board certification in sleep medicine or an individual who fulfills the eligibility criteria for the sleep medicine certification examination. PM may be used as an alternative to polysomnography (PSG) for the diagnosis of OSA in patients with a high pretest probability of moderate to severe OSA. PM is not appropriate for the diagnosis of OSA in patients with significant comorbid medical conditions that may degrade the accuracy of PM. PM is not appropriate for the diagnostic evaluation of patients suspected of having comorbid sleep disorders. PM is not appropriate for general screening of asymptomatic populations. PM may be indicated for the diagnosis of OSA in patients for whom in-laboratory PSG is not possible by virtue of immobility, safety, or critical illness. PM may also be indicated to monitor the response to non-CPAP treatments for sleep apnea. At a minimum, PM must record airflow, respiratory effort, and blood oxygenation. The airflow, effort, and oximetric biosensors conventionally used for in-laboratory PSG should be used in PM. The Task Force recommends that PM testing be performed under the auspices of an AASM-accredited comprehensive sleep medicine program with written policies and procedures. An experienced sleep technologist/technician must apply the sensors or directly educate patients in sensor application. The PM device must allow for display of raw data with the capability of manual scoring or editing of automated scoring by a qualified sleep technician/technologist. A board certified sleep specialist, or an individual who fulfills the eligibility criteria for the sleep medicine certification examination, must review the raw data from PM using scoring criteria consistent with current published AASM standards. Under the conditions specified above, PM may be used for unattended studies in the patient's home. Afollow-up visit to review test results should be performed for all patients undergoing PM. Negative or technically inadequate PM tests in patients with a high pretest probability of moderate to severe OSA should prompt in-laboratory polysomnography.
基于文献综述和共识，美国睡眠医学学会（AASM）便携式监测特别工作组提出以下建议：仅在结合全面睡眠评估的情况下，方可进行用于诊断阻塞性睡眠呼吸暂停（OSA）的无人值守便携式监测（PM）。使用PM进行的临床睡眠评估必须由具有睡眠医学委员会认证的从业者或符合睡眠医学认证考试资格标准的个人进行监督。对于中度至重度OSA预测试概率较高的患者，PM可作为多导睡眠图（PSG）诊断OSA的替代方法。对于可能降低PM准确性的重大合并症患者，PM不适用于OSA的诊断。PM不适用于疑似合并睡眠障碍患者的诊断评估。PM不适用于无症状人群的一般筛查。对于因行动不便、安全问题或危重症而无法进行实验室PSG检查的患者，PM可用于诊断OSA。PM也可用于监测睡眠呼吸暂停非持续气道正压通气（CPAP）治疗的反应。PM至少必须记录气流、呼吸努力和血液氧合情况。用于实验室PSG的气流、努力和血氧生物传感器应在PM中使用。特别工作组建议，PM检测应在AASM认可的综合睡眠医学项目的主持下进行，并制定书面政策和程序。经验丰富的睡眠技术专家/技术员必须应用传感器或直接指导患者应用传感器。PM设备必须能够显示原始数据，并具备由合格的睡眠技术人员/技术专家进行手动评分或编辑自动评分的能力。具有委员会认证的睡眠专家或符合睡眠医学认证考试资格标准的个人，必须使用与当前AASM发布标准一致的评分标准审查PM的原始数据。在上述规定条件下，PM可用于患者家中的无人值守研究。应对所有接受PM检查的患者进行随访以审查检测结果。对于中度至重度OSA预测试概率较高的患者，PM检测结果为阴性或技术上不充分时，应进行实验室多导睡眠图检查。
