Abstract
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.
Keywords
obstructive sleep apnea - polysomnography - ambulatory model - portable monitoring
- home diagnosis - screening questionnaires - autotitrating continuous positive airway
pressure
