Practice Parameters for the Indications for Polysomnography and Related Procedures: An Update for 2005

Practice Parameters april 05.qxp 3/17/2005 2:57 PM Page 499 PRACTICE PARAMETER Practice Parameters for the Indications for Polysomnography and Related Procedures: An Update for 2005 Clete A. Kushida, MD, PhD1; Michael R. Littner, MD2; Timothy Morgenthaler, MD3; Cathy A. Alessi, MD4; Dennis Bailey, DDS5; Jack Coleman, Jr., MD6; Leah Friedman, PhD7; Max Hirshkowitz, PhD8; Sheldon Kapen, MD9; Milton Kramer, MD10; Teofilo Lee-Chiong, MD11; Daniel L. Loube, MD12; Judith Owens, MD13; Jeffrey P. Pancer, DDS14; Merrill Wise, MD15 1Stanford University Center of Excellence for Sleep Disorders, Stanford, CA; 2VA Greater Los Angeles Healthcare System and David Geffen School of Medicine at UCLA, Sepulveda, CA; 3Mayo Sleep Disorders Center, Mayo Clinic, Rochester, MN; 4UCLA/Greater Los Angeles Healthcare System, Sepulveda, CA; 5Greenwood Dental Associates, Englewood, CO; 6Middle Tennessee ENT, Murfreesboro, TN; 7Stanford University School of Medicine, Stanford, CA; 8Baylor College of Medicine and VA Medical Center, Houston, TX; 9VA Medical Center and Wayne State University, Detroit, MI; 10Maimoides Medical Center, Psychiatry Department, Brooklyn, NY and New York University School of Medicine, New York, NY; 11National Jewish Medical and Research Center, Sleep Clinic, Denver, CO; 12Sleep Medicine Institute, Swedish Medical Center, Seattle, WA; 13Department of Pediatrics, Rhode Island Hospital, Providence, RI; 14Toronto, ON, Canada; 15Departments of Pediatrics and Neurology, Baylor College of Medicine, Houston, TX Summary: These practice parameters are an update of the previously-published recommendations regarding the indications for polysomnography and related procedures in the diagnosis of sleep disorders. Diagnostic categories include the following: sleep related breathing disorders, other respiratory disorders, narcolepsy, parasomnias, sleep related seizure disorders, restless legs syndrome, periodic limb movement sleep disorder, depression with insomnia, and circadian rhythm sleep disorders. Polysomnography is routinely indicated for the diagnosis of sleep related breathing disorders; for continuous positive airway pressure (CPAP) titration in patients with sleep related breathing disorders; for the assessment of treatment results in some cases; with a multiple sleep latency test in the evaluation of suspected narcolepsy; in evaluating sleep related behaviors that are violent or otherwise potentially injurious to the patient or others; and in certain atypical or unusual parasomnias. Polysomnography may be indicated in patients with neuromuscular disorders and sleep related symptoms; to assist in the diagnosis of paroxysmal arousals or other sleep disruptions thought to be seizure related; in a presumed parasomnia or sleep related seizure disorder that does not respond to conventional therapy; or when there is a strong clinical suspicion of periodic limb movement sleep disorder. Polysomnography is not routinely indicated to diagnose chronic lung disease; in cases of typical, uncomplicated, and noninjurious parasomnias when the diagnosis is clearly delineated; for patients with seizures who have no specific complaints consistent with a sleep disorder; to diagnose or treat restless legs syndrome; for the diagnosis of circadian rhythm sleep disorders; or to establish a diagnosis of depression. Key Words: Practice parameters; Practice guidelines; Standards of practice; Polysomnography; Sleep related breathing disorders; Sleep disorders; Narcolepsy; Parasomnias; Restless legs syndrome; Periodic limb movement sleep disorder; Insomnia; Circadian rhythm sleep disorders. Citation: Kushida CA; Littner MR; Morgenthaler T et al. Practice parameters for the indications for polysomnography and related procedures: An update for 2005. SLEEP 2005;28(4):499-521. 1.0 INTRODUCTION The conditions addressed included sleep related breathing disorders, other respiratory disorders, narcolepsy, parasomnias and sleep related seizure disorders, restless legs syndrome and periodic limb movement sleep disorder, depression with insomnia, and circadian rhythm sleep disorders. Since that time awareness of sleep disorders has grown. For example, in 1990 there were 110,000 office visits for sleep apnea. By 1998, this had risen to 1.3 million per year. The diagnosis of some sleep disorders requires objective documentation with PSG. Prior to 1997, the AASM had not published recommendations on most of the individual conditions that were addressed in the original practice parameters for PSG. Since then, there have been several AASM practice parameter publications that overlap with the focus of the recommendations of this paper. When such overlap occurs, this update will reference the relevant recommendations. The purpose of this update is to reissue, modify and, if necessary, replace recommendations for indications for PSG and related procedures based on the scientific literature published since 1997. The numbers in brackets refer to the sections in the review paper2 that accompanied the original practice parameter paper. IN 1997, THE AMERICAN ACADEMY OF SLEEP MEDICINE (AASM, FORMERLY THE AMERICAN SLEEP DISORDERS ASSOCIATION [ASDA]) published practice parameters for polysomnography (PSG) and related procedures.1 Disclosure Statement Dr. Kushida has received research support from GlaxoSmithKline, BoehringerIngelheim, Xenoport, and Pfizer; has received honoraria from GlaxoSmithKline; has received consulting fees from New Millennium Diagnostics, Inc.; and has received royalties as a licensor of a patented oral measurement device from Respironics, Inc. Dr. Littner is the principal investigator in research studies supported by GlaxoSmithKline, AstraZeneca, and Boehringer-Ingelheim; is on the speakers' bureaus for Boehringer-Ingelheim, Novartis, GlaxoSmithKline, and Pfizer; and has received honorarium from Boehringer-Ingelheim. Dr. Morgenthaler has received research support from Itamar Medical and ResMed. Dr. Alessi is a speaker for the Medical Education Speaker's Network; and is a consultant for Prescription Solutions. Dr. Owens has received research support from Eli Lilly, Sepracor, Cephalon, and Sanofi-Aventis; is a speaker for Eli Lilly and Johnson & Johnson; and is a consultant for Eli Lilly, Johnson & Johnson, Sepracor, Cephalon, and Sanofi-Aventis. Dr. Hirshkowitz is a speaker for Sanofi-Aventis and Cephalon; and has received honoraria from Sanofi-Aventis. Dr. Bailey is a partner in Dental Appliance Innovators Inc., this company developed the NORAD oral appliance. Drs. Friedman, Kapen, Kramer, Lee-Chiong, Loube, Wise, Coleman, and Pancer have indicated no financial conflicts of interest. Vol. 28, No. 4, 2005 DownloadedSLEEP, from https://academic.oup.com/sleep/article-abstract/28/4/499/2696969 by guest on 23 April 2018 2.0 METHODS The Standards of Practice Committee of the AASM reviewed the indications for polysomnography in the diagnosis of commonly encountered sleep disorders. On the basis of the revie (...truncated)