CHEST Guidelines-Does-Laboratory-Polysomnography-Yield-Better-Outco

Does-Laboratory-Polysomnography-Yield-Better-Outco

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The article presents a debate about the effectiveness of laboratory polysomnography (PSG) versus home sleep testing (HST) for diagnosing obstructive sleep apnea (OSA). Dr. Allan I. Pack advocates for laboratory polysomnography, arguing it provides more reliable and controlled results. He acknowledges that while home sleep studies are cost-effective and feasible for diagnosing OSA in some patients, they may not be suitable for all cases, particularly those with varying OSA severity. These home studies might not be as reliable in informing therapeutic decisions, potentially leading to misdiagnosis or under-treatment. Pack stresses the importance of comprehensive sleep centers managing OSA, as they can offer long-term care, and critiques the fragmented care model where durable medical equipment companies manage treatment after diagnosis.<br /><br />Conversely, Dr. Neil Freedman argues against the blanket superiority of PSG over HST, pointing out that advancements in technology and numerous studies support HST's viability. Freedman highlights that while PSG has traditionally been the gold standard, it isn't perfect due to night-to-night variability and other factors. He counters the argument that HST leads to higher failure rates, noting that while HST might need repeating in some cases, it remains cost-effective compared to PSG, which also has failure aspects not widely standardized or defined. Freedman advocates for the integration of HST into common practice, citing patient convenience and the overall equivalent outcomes in appropriate population subsets. <br /><br />Both authors agree on the ultimate aim: effective and sustained patient care post-diagnosis. They emphasize that sleep medicine should focus on chronic care management beyond mere testing. Overall, the debate underscores the need for a balanced approach, considering both clinical efficacy and patient-centric solutions in the management of OSA.

Keywords

laboratory polysomnography

home sleep testing

obstructive sleep apnea

diagnosis

Dr. Allan I. Pack

Dr. Neil Freedman

cost-effective

sleep centers

patient care

chronic care management