Portable Sleep Device Survey Australia & New Zealand 2005 ASTA Amanda Piper St John of God Sleep Centre, Perth, WA

Background Prevalence of OSAS for men & women is 4% and 2% respectively (Young et al., NEJM, 1993) Prevalence of OSAS for men & women is 4% and 2% respectively (Young et al., NEJM, 1993) Gold standard for diagnosis is attended PSG Gold standard for diagnosis is attended PSG Timely access to diagnosis and treatment is restricted in many countries (Flemons et al., AJRCCM, 2004) Timely access to diagnosis and treatment is restricted in many countries (Flemons et al., AJRCCM, 2004) Excessive waits lead to new technologies Excessive waits lead to new technologies Few current recommendations support the use of portable monitors (Chesson et al, AJRCCM, 2004) Few current recommendations support the use of portable monitors (Chesson et al, AJRCCM, 2004)

AIMS To assess the prevalence of portable device use in Australia and NZ in 2005 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 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 To generate discussion on the role of portable monitoring in sleep medicine today and in the future

Method Developed a questionnaire Developed a questionnaire Mailed survey to all known sleep services in Australia & NZ in July 2005 (N = 118) Mailed survey to all known sleep services in Australia & NZ in July 2005 (N = 118) Reminder sent to ASTA members in August 2005 Reminder sent to ASTA members in August 2005 Second mail out to non-responsive Sleep Services in September 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 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? Do you use portable monitors, and if so: are they used on-site or off-site? How many portable studies do you perform, using what system, what channels, and why do you use this system? How many portable studies do you perform, using what system, what channels, and why do you use this system?

ASDA review - Ferber et al, 1994, Sleep Sleep monitor classifications Type N o of channels NameDescription 112 Standard PSG Attended 27 Portable PSG Sleep stage, ECG, airflow, effort, SaO 2, unattended 34 Limited channel Incl. Airflow, SaO 2, effort, HR or ECG 4 1 or 2 Single or dual Oximetry and/or airflow

Portable Monitor usage

Home studies

Top 5 Portables in use MONITORTYPE NUMBER IN USE Compumedics Somté 318 Resmed Embletta 316 Compumedics P Series 212 Oximetry + Autoset 45 Oximetry alone 44

Top 5 Channels CHANNEL% SaO 2 100% Abdominal and Thoracic effort 84% Body Position 74% Sound (derived) 71% Pressure (nasal or CPAP) 58%

11 * cf. 4458/mth - Flemons et al, 2004 AJRCCM Structure of Sleep Services Total # of Services Total studies /month Type 1 50%3948*(86%) Type 2 13%48(1%) Type 3 26%465(10%) Type 4 11%153(3%)

Exclusion Criteria % of Total Barriers to monitoring 38 Heart disease/failure, AF, CSR 21 Physician defined 15 Sleep Hypoventilation, RF 10 Non-respiratory disorder e.g. PLMs, narcolepsy 8 Epilepsy, CSA 8

Reasons for use of Portable Monitors Reason for use Prop n Assess efficacy of treatment 79% Patients unable to attend the lab 79% Screen for OSA and proceed to CPAP or, if negative full PSG 68% Assess urgent patients 53% Increase throughput/reduce waitlist 42% Non-respiratory screening 13%

Sample comments Robust, confident of outcome, helpful in management Positives: study at home, reduce waiting time. Negatives: lack of sleep staging, inability to solve technical problems Careful consideration of procedure & interpretation of results required to ensure acceptable scientific standards and appropriate clinical decisions. Useful to fast track patients with strong history of SDB. If result negative, PSG required. Not cost effective to screen all patients.

Summary First survey of portable monitoring in Australia & NZ First survey of portable monitoring in Australia & NZ Despite few current recommendations supporting the use of portable monitors: Despite few current recommendations supporting the use of portable monitors: -Many sleep services use portable monitors -A number of services only use portable monitors Reasons for use revolve around freeing up treatment beds for diagnostic purposes, improving access to sleep services. Reasons for use revolve around freeing up treatment beds for diagnostic purposes, improving access to sleep services.

Acknowledgements ASTA Committee members Melissa Symonds - ASTA Treasurer Kim Ward – ASTA President