Standards for polysomnography
Online posting: February 27, 1997
Published in print: June 15, 1997 (CMAJ 1997;156:1698)
Re: Polysomnography: addressing the needs for standards, by Drs.
William A. Whitelaw and W. Ward Flemons, CMAJ
1996;155:1693-4 [full text / résumé]
In their editorial, Drs. William A. Whitelaw and W. Ward
Flemons support the standards for polysomnography of the Canadian
Sleep Society and the Canadian Thoracic Society (CSS/CTS). As
they indicate, the field of sleep disorders medicine cannot
achieve widespread recognition or credibility without appropriate
standards. However, some of their statements require
clarification.
Whitelaw and Flemons point out that there is no funding for
sleep studies or nasal continuous positive airway pressure (CPAP)
in Alberta. In Ontario, although funding for diagnosis and
therapy is readily available, it is neither comprehensive nor
open ended. The stated cost of approximately $1000 per patient is
just about double what is paid for full, overnight
polysomnography with physician supervision and reporting
(including both technical and professional fees and allowing for
government clawbacks). Moreover, the Assistive Devices Program of
the Ontario Ministry of Health provides 75% of the cost of CPAP
(up to a maximum) one time only. Continuing costs are not
covered. Compared with the coverage in Alberta, this may seem
"comprehensive and open ended." And indeed, such a fee schedule
has invited abuse, which is all the more reason to establish
standards.
The CSS/CTS standards have already been used as a template for
provincial standards in Alberta and Ontario. In 1994, the College
of Physicians and Surgeons of Ontario (CPSO) established a task
force to develop clinical practice parameters and facility
standards for sleep medicine. This document has recently been
completed. Under the direction of Dr. Gerry Gold of CPSO, and
task force cochairs Drs. Harvey Moldofsky and Murray Moffat, this
work extends the facility and test standards of the CSS/CTS
standards by including details on indications for sleep studies,
type of sleep studies, follow-up, post-sleep-study interventions
and medicolegal issues. (The document is available through Ms.
Corinne Berinstein, CPSO, tel. 416 967-2600.)
Sleep apnea is an extremely common sleep disorder that causes
significant rate of injury and death. Patients with sleep apnea
may consume more health care resources before diagnosis and
treatment than after.[1] Whitelaw and Flemons are correct in
stating that we need research on better and cheaper methods of
diagnosis and treatment. We must not, however, lose sight of the
fact that sleep apnea is but one of more than 75 sleep disorders,
each with its own associated problems. These cannot be addressed
without adequate training and appropriate application of the
diagnostic tools available.
Charles F.P. George, MD
Chair
Standards Committee
Canadian Sleep Society
Associate Professor of Medicine
University of Western Ontario
London, Ont.
cgeorge@julian.uwo.ca
Reference
- Kryger MH, Roos L, Delaive K, Walld R, Horrocks J.
Utilization of health care services in patients with severe
obstructive sleep apnea. Sleep 1996;19(9):S111-6.
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