The diagnosis of sleep-related breathing disorders

Information regarding sleep apnea syndromes and primary alveolar hypoventilation has been widely disseminated in both medical and lay publications. As a result, the pulmonary physician is confronted with a growing number of patients referred for evaluation of sleep-related breathing disorders. In addition, many pulmonary diseases may become worse during sleep. A wide variety of diagnostic options is available. The method chosen will depend on availability, cost, and the strength of the clinical impression. Screening studies, from the most simple (night-time Holter monitor or ear oximetry) to either a carefully performed nap study or a home recording may aid in deciding which patients require a formal polysomnogram. Centers with full all-night study capability may not use preliminary recordings at all. Because many therapeutic modalities exist, their intelligent use requires an accurate assessment of the type and severity of the breathing disorder.