Hostname: page-component-78c5997874-8bhkd Total loading time: 0 Render date: 2024-11-17T17:59:09.441Z Has data issue: false hasContentIssue false

Quality and relevance of evidence in support of guideline recommendations for sleep laboratory investigations

Published online by Cambridge University Press:  25 October 2005

David Hailey
Affiliation:
University of Alberta
Khai Tran
Affiliation:
Canadian Coordinating Office for Health Technology Assessment

Abstract

Objectives: As part of a review of guidelines for sleep laboratories, this study summarizes the quality and relevance of evidence cited in support of recommendations on investigations for individuals with sleep disorders.

Methods: Quality of evidence in support of each recommendation was rated as A (from well-conducted, prospective controlled studies), B (from controlled studies and case series, with minor shortcomings), or C (from case series or case series plus controlled studies with substantial limitations). Relevance of the cited evidence was also rated from A to C, in decreasing order of merit.

Results: Of eighty-one recommendations from thirty-seven guidelines, forty-six were supported by evidence from primary studies. Six recommendations were supported by category A evidence, fifteen by category B, and twenty-five recommendations by category C. The cited evidence was highly relevant to eighteen recommendations, of some relevance for twenty-two and of little or no relevance to six. Four recommendations were informed by an absence of available evidence. For the other thirty-one, no evidence was provided in support.

Conclusions: The approach used provided a concise overview of recommendations and supporting evidence for decision-makers. Guidelines on the use of sleep laboratory investigations contain much detailed information, but evidence supporting several recommendations is of limited quality and relevance. Furthermore, good-quality studies of many sleep laboratory applications are needed to assist both health policy formulation and clinical practice.

Type
GENERAL ESSAYS
Copyright
© 2005 Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Thoracic Society. 1996 Standards and indications for cardiopulmonary sleep studies in children. Am J Respir Crit Care Med. 153: 866878.
Chesson AL, Ferber RA, Fry JM, et al. 1997 The indications for polysomnography and related procedures. Sleep. 20: 423487.Google Scholar
Chesson AL, Wise M, Davila D, et al. 1999 Practice parameters for the treatment of restless legs syndrome and periodic limb movement disorder. An American Academy of Sleep Medicine Report. Standards of Practice Committee of the American Academy of Sleep Medicine. Sleep. 22: 961968.Google Scholar
Connecticut Thoracic Society, Connecticut Neurological Society. 2000 Obstructive sleep apnea, polysomnography, and split-night studies: Consensus statement of the Connecticut Thoracic Society and the Connecticut Neurological Society. Conn Med. 64: 465468.
Hailey D, Tran K, Dales R, Mensinkai S, McGahan L. A review of guidelines for referral of patients to sleep laboratories [Technology Report No 55]. Ottawa: Canadian Coordinating Office for Health Technology Assessment. Technology Report. May 2005. Available at: http://www.ccohta.ca.
Hornyak M, Kotterba S, Trenkwalder C, et al. 2002 Consensus statement from the German Sleep Society: Indications for performing polysomnography in the diagnosis and treatment of restless legs syndrome. Sleep Med. 3: 457458.Google Scholar
Indications for Polysomnography Task Force, Standards of Practice Committee, American Sleep Disorders Association. 1997 Practice parameters for the indications for polysomnography and related procedures. Sleep. 20: 406422.
Ipsiroglu OS, Kerbl R, Urschitz M, Kurz R. 2000 Österreichisches SIDS-Konsensus-Gespräch anässlich der Wiener SIDS-Präventionskampagne “Sicheres Schlafen” [4th Austrian SIDS-Consensus Meeting and Viennese SIDS prevention campaign “Safe Sleep”]. Wien Klin Wochenschr. 112: 187192.Google Scholar
Kerbl R. 2000 SIDS und Polygraphie [SIDS and polygraphic recordings]. Wien Klin Wochenschr. 112: 204208.Google Scholar
Littner M, Hirshkowitz M, Davila D, et al. 2002 Practice parameters for the use of auto-titrating continuous positive airway pressure devices for titrating pressures and treating adult patients with obstructive sleep apnea syndrome. An American Academy of Sleep Medicine report. Sleep. 25: 143147.Google Scholar
Littner M, Johnson SF, McCall WV, et al. 2001 Practice parameters for the treatment of narcolepsy: An update for 2000. Sleep. 24: 451466.Google Scholar
Littner M, Hirshkowitz M, Kramer M, et al. 2003 Practice parameters for using polysomnography to evaluate insomnia: An update. Sleep. 26: 754760.Google Scholar
Marcus CL, Chapman D, Ward SD, et al. 2002 Clinical practice guideline: Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics. 109: 704712.Google Scholar
Scottish Intercollegiate Guidelines Network. 2004. Management of obstructive sleep apnoea/hypopnoea syndrome in adults: A national clinical guideline. Edinburgh: The Network; 2003. Clinical guideline no 73. Available at: http://www. sign.ac.uk/pdf/sign73.pdf. Accessed August 13
Schechter MS, 2002 Section on Pediatric Pulmonology, Subcommittee on Obstructive Sleep Apnea Syndrome. Technical report: Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics. 109: e69. Available at: http://www.pediatrics.org/cgi/reprint/109/4/e69.pdf.Google Scholar
Schoch OD, Bloch KE, Bischof E, et al. 2001 Care of patients with obstructive sleep apnea syndrome in Switzerland. Oto Rhino Laryngol Nova. 11: 178185.Google Scholar
Task Force on Clinical Practice Parameters and Facility Standards for Sleep Medicine. 1996. Clinical practice parameters and facility standards for sleep medicine. 1st ed. Toronto: College of Physicians and Surgeons of Ontario;