Based on a review of literature and consensus, the Portable Monitoring Task Force of the American Academy of Sleep Medicine (AASM) makes the following recommendations: unattended portable monitoring (PM) for the diagnosis of obstructive sleep apnea (OSA) should be performed only in conjunction with a comprehensive sleep evaluation. Clinical sleep evaluations using PM must be supervised by a practitioner with board certification in sleep medicine or an individual who fulfills the eligibility criteria for the sleep medicine certification examination. PM may be used as an alternative to polysomnography (PSG) for the diagnosis of OSA in patients with a high pretest probability of moderate to severe OSA. PM is not appropriate for the diagnosis of OSA in patients with significant comorbid medical conditions that may degrade the accuracy of PM. PM is not appropriate for the diagnostic evaluation of patients suspected of having comorbid sleep disorders. PM is not appropriate for general screening of asymptomatic populations. PM may be indicated for the diagnosis of OSA in patients for whom in-laboratory PSG is not possible by virtue of immobility, safety, or critical illness. PM may also be indicated to monitor the response to non-CPAP treatments for sleep apnea.

At a minimum, PM must record airflow, respiratory effort, and blood oxygenation. The airflow, effort, and oximetric biosensors conventionally used for in-laboratory PSG should be used in PM.

The Task Force recommends that PM testing be performed under the auspices of an AASM-accredited comprehensive sleep medicine program with written policies and procedures. An experienced sleep technologist/technician must apply the sensors or directly educate patients in sensor application. The PM device must allow for display of raw data with the capability of manual scoring or editing of automated scoring by a qualified sleep technician/technologist. A board certified sleep specialist, or an individual who fulfills the eligibility criteria for the sleep medicine certification examination, must review the raw data from PM using scoring criteria consistent with current published AASM standards.

Under the conditions specified above, PM may be used for unattended studies in the patient's home. A follow-up visit to review test results should be performed for all patients undergoing PM. Negative or technically inadequate PM tests in patients with a high pretest probability of moderate to severe OSA should prompt in-laboratory polysomnography.

Citation:
Collop NA; Anderson WM; Boehlecke B; Claman D; Goldberg R; Gottlieb DJ; Hudgel D; Sateia M; Schwab R. Clinical guidelines for the use of unattended portable monitors in the diagnosis of obstructive sleep apnea in adult patients. J Clin Sleep Med 2007;3(7):737–747.

Clinical guidelines for the use of unattended portable monitors in the diagnosis of obstructive sleep apnea in adult patients. Portable Monitoring Task Force of the American Academy of Sleep Medicine.

Background: Actigraphy is increasingly used in sleep research and the clinical care of patients with sleep and circadian rhythm abnormalities. The following practice parameters update the previous practice parameters published in 2003 for the use of actigraphy in the study of sleep and circadian rhythms. Methods: Based upon a systematic grading of evidence, members of the Standards of Practice Committee, including those with expertise in the use of actigraphy, developed these practice parameters as a guide to the appropriate use of actigraphy, both as a diagnostic tool in the evaluation of sleep disorders and as an outcome measure of treatment efficacy in clinical settings with appropriate patient populations. Recommendations: Actigraphy provides an acceptably accurate estimate of sleep patterns in normal, healthy adult populations and inpatients suspected of certain sleep disorders. More specifically, actigraphy is indicated to assist in the evaluation of patients with advanced sleep phase syndrome (ASPS), delayed sleep phase syndrome (DSPS), and shift work disorder. Additionally, there is some evidence to support the use of actigraphy in the evaluation of patients suspected of jet lag disorder and non-24hr sleep/wake syndrome (including that associated with blindness). When polysomnography is not available, actigraphy is indicated to estimate total sleep time in patients with obstructive sleep apnea. In patients with insomnia and hypersomnia, there is evidence to support the use of actigraphy in the characterization of circadian rhythms and sleep patterns/ disturbances. In assessing response to therapy, actigraphy has proven useful as an outcome measure in patients with circadian rhythm disorders and insomnia. In older adults (including older nursing home residents), in whom traditional sleep monitoring can be difficult, actigraphy is indicated for characterizing sleep and circadian patterns and to document treatment responses. Similarly, in normal infants and children, as well as special pediatric populations, actigraphy has proven useful for delineating sleep patterns and documenting treatment responses. Conclusions: Recent research utilizing actigraphy in the assessment and management of sleep disorders has allowed the development of evidence-based recommendations for the use of actigraphy in the clinical setting. Additional research is warranted to further refine and broaden its

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Practice parameters for the use of actigraphy in the assessment of sleep and sleep disorders: an update for 2007.

Clinical Guidelines for the Use of Unattended Portable Monitors in the Diagnosis of Obstructive Sleep Apnea in Adult Patients

Objective To review evidence-based knowledge of pediatric obstructive sleep apnea syndrome (OSAS). Data Sources and Extraction We reviewed published articles regarding pediatric OSAS; extracted the clinical symptoms, syndromes, polysomnographic findings and variables, and treatment options, and reviewed the authors’ recommendations. Data Synthesis Orthodontic and craniofacial abnormalities related to pediatric OSAS are commonly ignored, despite their impact on public health. One area of controversy involves the use of a respiratory disturbance index to define various abnormalities, but apneas and hypopneas are not the only abnormalities obtained on polysomnograms, which can be diagnostic for sleep-disordered breathing. Adenotonsillectomy is often considered the treatment of choice for pediatric OSAS. However, many clinicians may not discern which patient population is most appropriate for this type of intervention; the isolated finding of small tonsils is not sufficient to rule out the need for surgery. Nasal continuous positive airway pressure can be an effective treatment option, but it entails cooperation and training of the child and the family. A valid but often overlooked alternative, orthodontic treatment, may complement adenotonsillectomy. Conclusions Many complaints and syndromes are associated with pediatric OSAS. This diagnosis should be considered in patients who report the presence of such symptoms and syndromes.

https://jamanetwork.com/journals/jamapediatrics/articlepdf/486098/pra50002.pdf

Pediatric Obstructive Sleep Apnea Syndrome

A data decoding system that includes a server-side proxy component and at least two back-end computers, where the server-side proxy component is configured, when it receives an encoding request from a client, to select a back-end computer to forward the encoding request to, based on either a pre-defined rule, load estimates for the at least two computers, estimated network throughputs across network paths to the two computers. In response to receiving this request, the back-end computer that is selected is configured to encode the request.

Hand held bar code readers or mobile computers with cloud computing services

Evaluation of a portable device based on peripheral arterial tone for unattended home sleep studies.

An automatic ambulatory device for detection of AASM defined arousals from sleep: the WP100.

Video data of successive image frames are processed in a digital camera or other video image data acquisition device immediately after acquiring the video data, or during post-processing of the video data at some time after acquiring the video data, to reduce the effects of unintended motion (jitter) of the hand-held devices by stabilizing the images A processing circuit used to calculate an estimate of motion between components of successive image frames as part of a MPEG-4 or other compression algorithm is also used to estimate motion upon which the video data are altered to stabilize the images The individual images may be pre-stabilized by using the results of stabilizing a prior image in order to reduce the amount of processing necessary to stabilize a current image

Processing of video data to compensate for unintended camera motion between acquired image frames

In a world where surveillance cameras are at every street corner, there is a growing need for synergy among cameras as well as the automation of the data analysis process. This paper deals with the problem of reidentification of objects in a set of multiple cameras inputs without any prior knowledge of the cameras distribution or coverage. The proposed approach is robust to change of scale, lighting conditions, noise and viewpoints among cameras, as well as object rotation and unpredictable trajectories. Both novel and traditional features are extracted from the object. Light and noise invariance is achieved using textural features such as oriented gradients, color ratio and color saliency. A probabilistic framework is used incorporating the different features into a human probabilistic model. Experimental results show that textural features improve the reidentification rate and the robustness of the recognition process compared with other state-of-the-art algorithms.

Object reidentification in real world scenarios across multiple non-overlapping cameras

The likelihood of a particular type of object, such as a human face, being present within a digital image, and its location in that image, are determined by comparing the image data within defined windows across the image in sequence with two or more sets of data representing features of the particular type of object. The evaluation of each set of features after the first is preferably performed only on data of those windows that pass the evaluation with respect to the first set of features, thereby quickly narrowing potential target windows that contain at least some portion of the object. Correlation scores are preferably calculated by the use of non-linear interpolation techniques in order to obtain a more refined score. Evaluation of the individual windows also preferably includes maintaining separate feature set data for various positions of the object around one axis and rotating the feature set data with respect to the image data for the individual windows about another axis.

Itsik Dvir

Papers

Evaluation of a portable device based on peripheral arterial tone for unattended home sleep studies.

An automatic ambulatory device for detection of AASM defined arousals from sleep: the WP100.

Processing of video data to compensate for unintended camera motion between acquired image frames

Object reidentification in real world scenarios across multiple non-overlapping cameras

Detecting objects in an image being acquired by a digital camera or other electronic image acquisition device