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Background  uPrevalence of OSAS for men & women is 4% and 2% respectively (Young et al., NEJM, 1993) Gold standard for diagnosis is attended PSG Timely access to diagnosis and treatment is restricted in many countries (Flemons et al., AJRCCM, 2004) Excessive waits lead to new technologies Few current recommendations support the use of portable monitors (Chesson et al, AJRCCM, 2004)\vZ=vj@      AIMS To assess the prevalence of portable device use in Australia and NZ in 2005 To assess the reason for the of use of portable monitors To generate discussion on the role of portable monitoring in sleep medicine today and in the future$d  Method Developed a questionnaire Mailed survey to all known sleep services in Australia & NZ in July 2005 (N = 118) Reminder email sent to ASTA members in August 2005 Second mail out to non-responsive Sleep Services in September 2005 , Questionnaire  &Some sample questions: Do you perform comprehensive PSG studies, and if so: how many and using what equipment? Do you use portable monitors, and if so: are they used on-site or off-site? 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S  62 `P   P*    6h6 `   R*  H  0޽h ? ̙3380___PPT10.;R  0L0 0|(  |x | c $eZ M Z x | c $fZ Ct4 Z N | C &A?asta05  ~ H | 0޽h ? 3f3f̙3f3fy___PPT10Y+D=' = @B +   0'L0 `x0(  xx x c $Z  `}  Z x x c $Z ` Z H x 0޽h ? 3___PPT10i.+^+D=' = @B +   0'L0 0(  x  c $0Z  `}  Z x  c $Z ` Z H  0޽h ? 3f3f̙3f3fy___PPT10Y+D=' = @B +   0'L0 0(  x  c $Z  `}  Z x  c $Z ` Z H  0޽h ? 3f3f̙3f3fy___PPT10Y+D=' = @B +   0'L0 h$(  hr h S \Z  `}  Z r h S 4Z ` Z H h 0޽h ? 3___PPT10i.?pG+D=' = @B +   0'L0b$ NASDA review - Ferber et al, 1994, Sleep "7.(  ~  s *Z  `}  Z p /`;  4 #"&TD/` Z  <Z? `;  Oximetry and/or airflow   @`  <Z? ;  jSingle or dual   @`  <s? ;  d1 or 2   @`  < s? ;  a4   @`    <s? `  &Incl. Airflow, SaO2, effort, HR or ECG,'  '  @`   <#s?  kLimited channel   @`   <,s?   _4   @`   <5s?   a3   @`   <7s? `  3Sleep stage, ECG, airflow, effort, SaO2, unattended,4&   4  @`  <,Js?  h Portable PSG     @`  <Ts?  _7   @`  < ]s?  a2   @`  <es? ^` dAttended     @`  <ns?^  h Standard PSG     @`  <ws?^ `12   @`  <s?^ a1   @`  <\s? /`^ m Description     @`  <hs?/ ^ fName   @`  <(s?/^ No of channels@    @`  <s?/^ hType   @`fB  6o ?/`/`B  01 ?^`^`B  01 ?``B  01 ? ` `B  01 ? ` fB  6o ?; `; fB  6o ?/; `B   01 ?/; `B ! 01 ?/; `B " 01 ? / ; fB # 6o ?`/`; H  0޽h ? 3f3f̙3f3f___PPT10e.+D=' = @B +   0'L0 Ld(  Lr  L S Ds  `}  s  L0  fA u?AA ?' u sH L 0޽h ? 3___PPT10i.4@_+D=' = @B +g   0'L0 vn (  x  c $s  `}  s   HA ,??u  , s  0  fA w?AA ? Y w sH  0޽h ? 3f3f̙3f3fy___PPT10Y+D=' = @B +   0'L0 0'm(  r  S   `}   x  m #"*, T M < ?"`{   xOximetry alone   @` K <* ?"`O  {  Oximetry + Autoset4     @` I <: ?"`J  O  ~Compumedics P Series     @` G <+ ?"` J  Resmed Embletta4     @`$ E <N ?"`  Compumedics Somt @       @` C <TH ?"`  iMONITOR   @` * <`?3 {  _4   @` ) <i? { 3  _4   @` ( <r?3 O {  _5   @` ' <{? O 3 {  _4   @` & <?3 J O  `12   @` % <? J 3 O  _2   @` $ < ?3 J  `16   @` # <ԟ? 3 J  _3   @` " <?3  `18   @` ! <4? 3  _3   @`   <?3  q NUMBER IN USE   @`  <? 3  hTYPE   @`fB + 6o ? fB , 61 ? fB - 61 ? fB . 61 ?J  J fB / 61 ?O  O fB 0 61 ?{  { fB 1 6o ? fB 2 61 ?`B 3 01 ?3 3 fB 4 6o ?fB D 61 ?  fB U 6o ? `B V 01 ? `B Y 01 ? `B \ 01 ? J J `B _ 01 ? O O `B b 01 ? { { fB e 6o ? H  0޽h ? 3___PPT10i.P+D=' = @B +z   0'L0 yq@90 (  0r 0 S   `}   W ,Y 90 #"*j,Y  0 <<?X ,Y _58%   @` 0 <?X Y rPressure (nasal or CPAP)   @` 0 < ?Y ,X  _71%   @`  0 <p?Y X  iSound (derived)   @`  0 <8?Z ,Y  _74%   @`  0 <?Z Y  g Body Position   @`  0 <t?Y,Z  _84%   @`  0 <,?YZ  wAbdominal and Thoracic effort   @` 0 <?Z,Y `100%   @` 0 <&?ZY hSaO2   @` 0 <?,Z c%   @` 0 <8?Z gCHANNEL   @`fB 0 6o ?,`B 0 01 ?Z,Z`B 0 01 ?Y,Y`B 0 01 ?Z ,Z `B 0 01 ?Y ,Y `B 0 01 ?X ,X fB 0 6o ?Y,YfB 0 6o ?Y`B 0 01 ?YfB 0 6o ?,,YH 0 0޽h ? 3___PPT10i./E+D=' = @B +%   0'L0j, V* cf. 4458/mth - Flemons et al, 2004 AJRCCM `ER(  x  c $F  `}     `" E #"&()(( `"  ( <? `" u 153 (3%)     ) <K? " e11%    * <]?  " pType 4   + <@g? `  v 465 (10%)     , <o?  e26%    - <x?    pType 3   . <? `  t48 (1%)     / <h?  e13%    0 <?   pType 2   1 <؝? r`  3948* (86%)     2 <h?r  m50%   3 <ܯ? r pType 1   4 < ? `r Total studies /month   5 <x? r Total # of Services   6 <? r X   fB 7 6o ? ``B 8 01 ? r`r`B 9 01 ? ``B : 01 ?  ` `B ; 01 ?  ` fB < 6o ? "`"fB = 6o ?  "`B > 01 ?"`B ? 01 ?  "fB @ 6o ?``"H  0޽h ? 3f3f̙3f3fy___PPT10Y+D=' = @B +  0'L0   5(  x  c $8_  `}   | P 5 #"."nT>bNrPw  <(?` p  J15 @`  <?Pp`  YPhysician defined @`  <`?`  J38 @`   <?P`  ^Barriers to monitoring @`   <?` f  I8 @`   <x ?Pf `  U Epilepsy, CSA @`   <H?`  f  I8 @`<  <?P ` f  ^Non-respiratory disorder e.g. PLM s, narcolepsy00  @`  <| ?`   J10 @`  <(?P `   bSleep Hypoventilation, RF  @`  <9?` p J21 @`  <|3?P` p fHeart disease/failure, AF, CSR @`  <K?`  Z % of Total   @`  <T?P`  `Exclusion Criteria @`fB  6o ?P`B  01 ?P`B  01 ?Ppp`B  01 ?P  `B  01 ?Pf f fB  6o ?PfB  6o ?PP`B   01 ?` ` fB " 6o ?`B # 01 ?P`B $ 01 ?P  H  0޽h ? 3y___PPT10Y+D=' = @B +   0'L0 [.(  r  S =  `}   | T]`  [ #"."PsO]W]T`Y  L <_?]`| {Propn0   @` J <a?T]| pReason for use   @`  <`y?V `  a13%   @`  <?TV   uNon-respiratory screening   @`  <{? `V  a42%   @`  <?T V  #Increase throughput/reduce waitlist$$ $  @`  <? `  i53%  @`   <̧?T   zAssess urgent patients  @`   <x?`  i68%  @`   <ij?T  ;Screen for OSA and proceed to CPAP or, if negative full PSG<<;  @`   <?` i79%  @`   <d?T FPatients unable to attend the  lab $$#  @`  <?|` i79%  @`  <@?T| Assess efficacy of treatment  @`fB  6o ?T]`]`B  01 ?T``B  01 ?T``B  01 ?T ` `B  01 ?T ` `B  01 ?TV `V fB  6o ?T ` fB  6o ?T]T `B  01 ?] fB  6o ?`]` `B K 01 ?T|`|H  0޽h ? 3___PPT10i.PKK+D=' = @B +t   0'L0 sk(  x  c $<  `}   M GS v  3 #" <7` ]  B0?GS v VNF___PPT9(  3Robust, confident of outcome, helpful in management64(" d3"NB  S GS S NB  S Gv v NB  S GS Gv NB  S S v | T`   #" T`     B@?T` VNF___PPT9(  wPositives: study at home, reduce waiting time. Negatives: lack of sleep staging, inability to solve technical problems:x(" dwbBNB   S T`NB   S T ` NB   S TT NB  S ``    , # #" ^s '   B?  ,VNF___PPT9(  Careful consideration of procedure & interpretation of results required to ensure acceptable scientific standards and appropriate clinical decisions.6(" d"NB  S    NB  S  ,,NB  S   ,NB  S  ,| `D   #" `D    BT?`D VNF___PPT9(  Useful to fast track patients with strong history of SDB. If result negative, PSG required. Not cost effective to screen all patients.:(" dbB NB  S `NB  S D `D NB  S D NB  S ``D H  0޽h ? 3___PPT10i.`O>+D=' = @B +   0'L0 0(  x  c $   `}   x  c $ `  H  0޽h ? 3___PPT10i.6n+D=' = @B +   0'L0 z(  r  S ,4Z  `}  Z x  c $5Z c  Z   c AZasta_logoAustralasian Sleep Technologists Association"`( ZH  0޽h ? 3___PPT10i.0.R+D=' = @B + 0  (  X  C      S G @   " H  0޽h ? ̙33 0 XPp(  X  C    P  S M @   @Total services includes multiple portable monitors in the one  centre . Type 1 studies, total studies compares favourably with a study published last year in the  blue journal by Flemons and Douglas, which reported a total number of Type 1 studies of 53,500/yr (with a response rate of 60%) versus our results = 46992 (Flemons et al, 2004) Portable studies account for 666 studies per month, which is 17% of the PSG total. Thus a significant number of patients are able to be investigated beyond the number of full PSG beds available. In the UK, 2/3 of all sleep studies are oximetry alone (Type 4), 20% are limited and only 10% are full PSG. 4614 studies/mth, 1153/wk.p   ;      J    H  0޽h ? ̙3380___PPT10.& 0  ,(  ,X , C     , S m @   [33% of PMs applied by a tech at the lab versus 30% applied by a tech at the patients home. &  R H , 0޽h ? ̙3380___PPT10.-P1  0 <48(  8X 8 C    4 8 S o @   All labs selected multiple reasons for using portable monitors dependant on the patient. (eg limited mobility, very sick, financial hardship etc)  Y 8 H 8 0޽h ? ̙3380___PPT10.3oZ  0   p| (  |^ | S      | c $v @    As we are all keenly aware - OSA is a highly prevalent disorder with estimates that it afflicts up to 5% of the population of the Western world (Young et al 2004). This prevalence  combined with increased awareness of the disorder in the general population is placing increasing pressure on the existing health care system to provide prompt diagnosis & treatment. The capacity for performing attended PSG in Australia and NZ is inadequate to deal with the demand  resulting in excessive wait-lists. Excessive waits lead to PSG alternatives. Many portable devices have been developed over the last 5 years in response to the demand for a more efficient and cost-effective mechanism to investigate patients suspected of SDB. There have been a number of efforts to evaluate the utility of portable monitoring. Currently, there remains a lack of evidence in the literature indicating that these alternative strategies offer comparable outcomes for patients. However, as John Stradling has so passionately articulated at preceding sessions, from a clinical point of view, it must be recognised that evidence based medicine will always be behind the curve of progress. T    b   L H | 0޽h ? ̙3380___PPT10.+@:} 0 (  ^  S      c $} @   First time portable monitoring reviewed was in 1994 and this review classified sleep monitors into 4 types. This classification standard has been used for all subsequent reviews and is the standard I will follow in presenting our results. Type 1: Attended comprehensive PSG Type 2: Comprehensive portable PSG (must be able to sleep stage) Type 3: Minimum 4 channels including ventilation/airflow, HR or ECG and SaO2 Type 4: Single or dual parameters; does not fit Type 3 criteria r:F9  H  0޽h ? ̙3380___PPT10.,[M!\ 0 l(  ^  S      c $ @   b:Overall the responses had a similar  feel to them: essentially portable devices allow us to access more patients than we would normally be able to assess  however the monitors have limitations (signal loss and an inability to clearly define sleep time being the prominent complaints)  H  0޽h ? ̙3380___PPT10.4= 0 1(  ^  S      c $ @   'In summary we believe this to be the first survey of portable monitoring in Australia & NZ. Reasons for applying portable monitors revolve around accessing a wider patient group, and freeing up resources and treatment beds for diagnostic purposes  H  0޽h ? ̙33( 0 P8(  X  C      S  @   :ECG - 55% EEG- 39%  H  0޽h ? ̙3380___PPT10.]йC 0 0(  ^  S      c $ @   uBarriers to monitoring include; unco-operative, no transport, poor mobility, language, morbid obesity, staff safety. H  0޽h ? ̙33x} xdGqp4st-kWK$dczVKyfu^ 9 8pb + !``I$z~uH+N|=3]]]]]]U} ~=͞;c-#3?οp(|dl~cL(lxA[.2_|o?B^ *"2PB涒`eʦ/Yj`3l _f!a BHڏXjq|c2>?B.< VH<`B R2X9  TCP B=BFM!@hFmcBB'.z Ba !Aa(vBa7C AaB{!!\jG 0 a 4k 0aµc(׌]/<~ o@8&!' 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