ROLE OF SLEEP LABORATORY IN MANAGEMENT OF SLEEP
DISORDERED BREATHING
Panelists: Sarat Kuchipudi, MD; Naeem Lughmani, MD; Charlene Oledick, RRT, RPsgT; Amy Miller, RRT,
RPsgT (from left to right)
• • Attended Polysomnogram in a Sleep Laboratory is gold standard for
diagnosis of sleep disordered breathing
• Ideal wait time for diagnostic PSG should not be more than 2-3 weeks
• Mostly, MSLT after a PSG is not needed. Approximately not more than
20% of diagnostic PSGs should be followed by MSLT
• MSLT testing should not be done following a CPAP titration study as
CPAP titration study night is not a normal night for an individual and has not
achieved best possible sleep
• CPAP titration study benefits: patient education, acclimatization to mask,
equipment, pressure guidance, identifying when unresponsive/intolerance to
CPAP and need Bi-Level therapy
• Empiric CPAP therapy with patient education and mask fitting and
acclimatization: less costly; if patient does not feel better or cannot tolerate
machine; consider CPAP titration therapy
• Split Night Sleep Study: alternative to 2 night study especially if there is
long wait time before studies can be done; if first 2 hours of sleep time
suggest features of obstructive sleep apnea (AHI >20/h, oxygen desaturation,
snoring), one can do split night study and start CPAP titration provided about
4 hours of sleep are remaining.
• Hypnotic before sleep studies should be used per policy of sleep lab and
preference of lab director.