A Review of Guidelines for Referral of Patients to Sleep Laboratories

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Technology Name
Examinations performed in sleep laboratories

Disease or Condition
Conditions include obstructive sleep apnea in adults and in children, other conditions that produce sleep disturbances, respiratory disorders, sudden infant death syndrome, insomnia, depression with insomnia, narcolepsy, parasomnias, restless legs syndrome and periodic limb movement disorder.

Technology Description
Patients who stay overnight in a sleep laboratory are monitored while asleep using polysomnography (PSG), which measures and records multiple physiological parameters. Investigation of excessive daytime sleepiness is undertaken in sleep laboratories using the multiple sleep latency test or the maintenance of wakefulness test.

The Issue
Sleep laboratories are specialized facilities and demand for their services is increasing. Health care providers need assurance that the examinations and services in sleep laboratories are clinically appropriate.

Assessment Objectives
Our aim was to identify recommendations for the investigation of individuals in sleep laboratories, as made in guidelines prepared by professional bodies; and to review the nature, quality and relevance of the evidence cited in support of these recommendations.

Methods
Using a literature search, we identified the guidelines that were prepared by professional bodies on the use of sleep laboratory investigations for sleep disorders. For each application, pertinent guideline recommendations for and against the use of sleep laboratory examinations were listed. The quality and relevance of evidence from primary studies cited in support of the guidelines were assessed.

Conclusions

• The reviewed guidelines contain detailed information for health professionals. Many recommendations are supported by studies on sleep laboratory applications.
  

• The evidence for some applications is of limited quality and the cited studies are not always directly relevant to the recommendations made. Several recommendations reflect consensus positions and no evidence is cited in support.
  

• Evidence of relatively good quality was provided for the use of sleep laboratory examinations in obstructive sleep apnea, though recommendations on this application differed.
  

• Evidence supporting recommendations on sleep laboratory testing in relation to sudden infant death syndrome, insomnia; and depression and insomnia is also of reasonable quality and relevance.
  

• Further good quality studies of many sleep laboratory applications are needed.

This summary is based on a comprehensive health technology assessment available from CCOHTA’s web site . Hailey D, Tran K, Dales R, Mensinkai S, McGahan L. A review of guidelines for referral of patients to sleep laboratories.