Sleep Disorders and Sleep Deprivation An Unmet Public Health Problem (2006) / Chapter Skim
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6 Ensuring Adequate Diagnosis and Treatment: Access, Capacity, and Technology Development
6 Ensuring Adequate Diagnosis and Treatment: Access, Capacity, and Technology Development
Pages 217-232
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Further, the current diagnostic and therapeutic capacity is not sufficient for the present demand, let alone the predicted increase in demand arising from the proposed public education campaign. Thus, additional technology development is required.
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There are currently an estimated 1,292 sleep centers or laboratories in the United States, 39 percent of which were accredited by the American Academy of Sleep Medicine (AASM) (Tachibana et al., 2005)
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, and costs related to consumable supplies used for monitoring. Most insurers require sleep laboratories to be supervised by physicians or other clinicians certified by the American Academy of Sleep Medicine.
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220 SLEEP DISORDERS AND SLEEP DEPRIVATION dren or parents) responsibilities.
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Thus, there is interest in use of simpler technology with sufficient predictive value to be used in decision making. Technological advances also have led to the incorporation and packaging of various groups of sensors, many novel, designed to provide simpler means for quantifying airflow limitation or breathing effort, oxygen desaturation, snoring sounds, movement, heart rate, blood pressure, and vascular tone variability.
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There are several challenges to technology development and evaluation that may be fairly specific to sleep medicine. Challenges relate to the underlying uncertainty over: (1)
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have used a single metric such as the AHI for defining sleep apnea, or the periodic limb movement index (PLMI) for periodic limb movement disorder, defining disease by using a single cutoff value for each (e.g., AHI greater than 5 for sleep apnea or PLMI greater than 5 for periodic limb movement disorder)
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224 SLEEP DISORDERS AND SLEEP DEPRIVATION using a careful history; lung function tests are used to gauge disease severity and treatment responses and sometimes to help differentiate asthma from other respiratory conditions. The issues that plague equipment development and laboratory access in the sleep laboratory have not impeded the development of lung function laboratories.
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. An executive summary on the systematic review and practice parameters for portable monitoring in the investigation of suspected sleep apnea in adults was published in 2004 by an evidence review committee consisting of members from the American Thoracic Society, the American College of Chest Physicians, and the American Academy of Sleep Medicine (ATS, 2004; Flemons and Littner, 2003)
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. Problematically however, the MSLT is sensitive to sleep deprivation and sleep-disordered breathing; thus, the test is often difficult to interpret.
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Biochemical and imaging research aiming at discovering biomarkers of sleep debt and sleepiness is also needed. Other Diagnostic Technologies In addition to the development of ambulatory strategies, efforts are also currently under way to utilize other techniques to diagnose individuals who suffer chronic sleep loss or sleep disorders.
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. FUTURE DIRECTIONS Given the cumbersome nature and cost of the diagnosis and treatment of sleep disorders and sleep loss, the resultant inequities with regard to access, and in order to ensure future quality care, greater investment in the development of new, and validation of existing, diagnostic and therapeutic technologies is required.
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Further, development of new technologies such as ambulatory monitoring, biological markers, and imaging techniques should be vigorously supported. REFERENCES AASM (American Academy of Sleep Medicine)
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Sleep Medicine Reviews 8(4)
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2004. Using a wrist-worn device based on peripheral arterial tonometry to diagnose obstructive sleep apnea: In-laboratory and ambulatory validation.
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Journal of Clinical Sleep Medicine 1(1)
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