. Sleep, 20(6):423-487 © 1997 American Sleep Disorders Association and Sleep Research Society An American Sleep Disorders Association Review The Indications for Polysomnography and Related Procedures Andrew L. Chesson, Jr., Richard A. Ferber, June M. Fry, Madeleine Grigg-Damberger, Kristyna M. Hartse, Thomas D. Hurwitz, Stephen Johnson, Gihan A. Kader, Michael Littner, Gerald Rosen, R. Bart Sangal, Wolfgang Schmidt-Nowara and Aaron Sher ASDA Polysomnography Task Force Summary: This paper is a review of the literature on the use of polysomnography in the diagnosis of sleep disorders in the adult. It is based on a search of MEDLINE from January 1966 through April 1996. It has been reviewed and approved by the Board of Directors of the American Sleep Disorders Association and provides the background for the accompanying ASDA Standards of Practice Committee's Parameters for the Practice of Sleep Medicine in North America. The diagnostic categories reviewed are: sleep-related breathing disorders; other respi- ratory disorders; narcolepsy; parasomnias and sleep-related epilepsy; restless legs syndrome and periodic limb movement disorders; insomnia; and circadian rhythm sleep disorders, Where appropriate, previously published practice parameters papers are cited and discussed, The relevant published peer-reviewed literature used as the basis for critical decisions was compiled into accompanying evidence tables and is analyzed in the text. In the section on the assessment of sleep apnea syndrome, options for estimating pretest probability to select high risk patients are also reviewed, Sleep-testing procedures other than standard polysomnography are also addressed (daytime polysomnography, split-night studies, oximetry, limited full respiratory recordings, and less-than-full respiratory recording) and treatment-related fulluw-up studies are discussed. Key Words: Practice parameters-practice guide- lines-Standards of practice-Polysomnography-Sleep apnea syndrome-Sleep disorders-Narcolepsy-Parasom- nias-Restless legs syndrome-Periodic limb movement disorder-Insomnia-Circadian rhythm disorders. 1:0 INTRODUCTION 2.0 HISTORIC INFORMATION Polysomnogniphy (PSG) is a recording of multiple physiologic parameters relevant to sleep, Traditionally, clinical studies have used a typical recording montage that includes electroencephalography (EEG), electro- oculography (EOG), chin electromyography (EMG), respiratory effort, airflow, electrocardiography (ECG), oximetry, and anterior tibialis EMG (1); one or several channels of each of these parameters allow for nec- essary data acquisition. Recently, however, sleep-test- ing procedures performed with fewer channels have been proposed as adequate to diagnose some sleep dis- orders (2-25). The purpose of this background paper is to evaluate the literature to determine when PSG or other sleep-testing procedures are indicated for the di- agnosis of a variety of sleep disorders and what the necessary recording variables are for each specific di- PSG and clinical sleep medicine originated in the late 1950s and have evolved together. Their beginnings were precipitated by the discoveries and characteriza- tions of rapid eye movement (REM) sleep and sleep apnea. Rapid eye movement sleep was first described by Kleitman, Aserinsky, and Dement in Chicago (26,27) and subsequently by Jouvet, Michel, and Mounier in France (28). In the mid-1960s, two groups of European researchers (29,30) made observations about the correlations between upper airway obstruc- tion and disturbed sleep, thereby discovering sleep ap- nea. During the burgeoning clinical and basic research that followed the discoveries of REM sleep and sleep apnea, PSG was the essential tool to investigate sleep and its disorders and became the accepted standard for clinical practice. Efficient clinical use of PSG increas- ingly became an issue in the late 1980s, partly because agnosis. Accepted for publication March 1997. of concerns over rapidly rising healthcare costs in the United States. Because of the simultaneous develop- ment of PSG and sleep medicine, the great majority 423 Downloaded from https://academic.oup.com/sleep/article/20/6/423/2732136 by guest on 03 October 2023