Adelaide Institute for Sleep Health, Repatriation General Hospital, Daw Park, SA, Australia.
Semin Respir Crit Care Med. 2014 Oct;35(5):545-51. doi: 10.1055/s-0034-1390139. Epub 2014 Oct 29.
The prevalence of obstructive sleep apnea (OSA) has been steadily rising over recent decades and patient access to laboratory-based sleep services and specialist consultations have become increasingly limited, resulting in potential delays in treatment. As a result, there has been growing interest in the use of non-sleep laboratory methods for diagnosing and managing OSA, including the use of screening questionnaires, portable sleep monitoring devices, and home autotitrating continuous positive airway pressure. There is also evidence in support of a role for alternative health care professionals, such as sleep-trained nurses and primary care physicians in the diagnosis and treatment of OSA. In this review, we compare the different types of home monitoring devices, discuss the limitations of portable monitoring compared with full laboratory polysomnography, and summarize the results from published comparative effectiveness studies which have evaluated ambulatory models of care for the management of OSA. We also consider how future models of care that may be needed to deal with the burden of disease will evolve and some of the issues that prevent the translation of such models of care in many countries.
阻塞性睡眠呼吸暂停（OSA）的患病率在最近几十年中稳步上升，患者获得基于实验室的睡眠服务和专家咨询的机会越来越有限，导致治疗可能出现延误。因此，人们越来越感兴趣使用非睡眠实验室方法来诊断和管理 OSA，包括使用筛查问卷、便携式睡眠监测设备和家庭自动滴定持续气道正压通气。此外，有证据支持替代医疗保健专业人员（如睡眠训练护士和初级保健医生）在 OSA 的诊断和治疗中的作用。在这篇综述中，我们比较了不同类型的家庭监测设备，讨论了与全实验室多导睡眠图相比便携式监测的局限性，并总结了已发表的评估用于管理 OSA 的门诊护理模式的比较有效性研究的结果。我们还考虑了未来可能需要应对疾病负担的护理模式将如何发展，以及在许多国家阻碍这种护理模式转化的一些问题。
