The Canadian Medical Association Journal (CMAJ) published research on a hotly-debated topic this month, running a lengthy study comparing the diagnostic accuracy of level three portable sleep tests versus level one polysomnography for sleep-disordered breathing.
Researchers at the University of Alberta did a systematic review and meta-analysis with an initial assumption that sleep testing using level three portable devices may expedite diagnosis and reduce the costs associated with level one in-laboratory polysomnography. “We sought to assess the diagnostic accuracy of level 3 testing compared with level 1 testing,” wrote researchers, “and to identify the appropriate patient population for each test.”
Researchers conducted a systematic review and meta-analysis of comparative studies of level 3 versus level 1 sleep tests in adults with suspected sleep-disordered breathing. They searched three research databases and grey literature sources for studies that reported on diagnostic accuracy parameters or disease management after diagnosis.
Two reviewers screened the search results, selected potentially relevant studies and extracted data. They used a bivariate mixed-effects binary regression model to estimate summary diagnostic accuracy parameters.
Researchers concluded that level three sleep studies are safe and convenient for diagnosing obstructive sleep apnea in patients with a high pretest probability of moderate to severe forms of the condition without substantial comorbidities.
“Level 1 polysomnography remains the cornerstone for the diagnosis in patients suspected of having comorbid sleep disorders, unstable medical conditions or complex sleep-disordered breathing,” wrote researchers. “Further studies assessing the use of portable sleep studies in patients with conditions other than obstructive sleep apnea, and in patients with obstructive sleep apnea and comorbidities, are needed.”