[Diagnosis of sleep apnea: initial experiences with a staged procedure]

The high prevalence of sleep-related breathing disturbances (SRBD), in association with cardiopulmonary disease, and the impairment by such disorders of the quality of the patients life, together with the good response of SRBD to therapy when diagnosed early on, point up the importance of incorporating the diagnostic evaluation of SRBD into the routine medical and pneumological diagnostic work-up. Since classical polysomnography requires a considerable effort, a stepwise diagnostic procedure was needed for use in practice. This includes a narrowing down of the indications, a brief questionnaire and a detailed questionnaire. For positive demonstration of a respiratory disturbance or differential diagnostic purposes, the following measures are employed on an outpatient basis in the following order: High-resolution 24-hour (Holter) ECG; analysis of heart rate and respiratory sounds, including, in particular snoring, with the MESAM system; induction plethysmography and continuous oxygen partial pressure measurement (pO2tc). Only after exhaustive use has been made of the ambulatory work-up, are the following diagnostic inhospital measures employed in the order indicated: 10-channel recording using the SIDAS system (respiration 3 channels, oxygen saturation, EOG, actogram, heart rate, intrathoracic pressure fluctuations), complete polysomnography. Once SRBD has been established, the patient is sent to the sleep laboratory to establish a baseline. Baseline measurement is accompanied by the determination of a marker, that is, a readily determined parameter capable of providing information about the success of therapy, is established. This permits complete polysomnography to be concentrated on differential-diagnostic and treatment-refractory problem cases.(ABSTRACT TRUNCATED AT 250 WORDS)