[How to set up a sleep laboratory in a community general hospital]

In Japan, sleep-related disorders (SRD) have been handled by only a few university teams, and mainly on a research basis, because polysomnography (PSG) is labor-intensive, expensive, and unprofitable. Although public consciousness of SRDs has been raised by mass-media campaigns, the situation is far from ore that would meet patient's demands. We have done 1476 PSG tests over about five years, and diagnosed more than 600 cases of SRDs. Therapy included nasal continuous positive airway pressure in 170 cases, prosthetic mandibular advancement in 55 cases, and uvulopalatopharyngoplasty and related operations in 97 cases. We describe how we set up a sleep laboratory and a care system, and how to circumvent problems. Several points related to the selection of patients for PSG in daily clinical practice can be clarified with our data. Computerized sleep respiratory analyser might save time and money, but their advantages and disadvantages should be studied. The approach to SRDs should be comprehensive and systematic, and polysomnographers play an important role. We need programs organized by scientific institutions to train polysomnographers. Research should continue not only on scientific aspects of SRDs but also on the way patients with SRDs are cared for. Reasonable insurance coverage of the costs of nosal continuous positive airway pressure and of PSGs is essential for widespread access to these services.