Controversies in sleep disorders medicine. Pulmonologists respond!

Herein we report the results of an informal survey of approximately 350 physicians attending the American College of Chest Physicians meeting in October 1995.

With response computer technology, we polled session participants about sleep and sleep disorders. The responses to the questions were instantaneously displayed and recorded and are presented herein.

We found considerable expertise and experience in our audience; 65% were board certified in pulmonary medicine and 12% in sleep disorders medicine. There was not agreement about expectations upon referral of a patient to a sleep center or about the definitions of either sleep apnea or hypopnea. Most sleep centers perform split-night polysomnography but there is not a single clear indication for this procedure and there is uncertainty about the efficacy of split-night studies. Most laboratories represented recognize the diagnosis of upper airways resistance syndrome, and respondents seemed well versed in the definition of this entity. There was not uniform agreement of the treatment effects of mild or positional obstructive sleep apnea.

Pulmonologists appear to be interested in and knowledgeable about sleep disorders. There are several basic areas of controversy, emphasizing the need for clinical research in the area of sleep-disordered breathing.