Authors' objectives:

This report evaluates the clinical utility and cost-effectiveness of polysomnography (PSG) in the diagnosis and management of sleep disorders.

Authors' recommendations: Considerations for Policy Development Obesity, rather than obstructive sleep apnea (OSA), leads to cardiovascular consequences. Treating and preventing obesity would substantially reduce the economic burden associated with diabetes, hypertension, hyperlipidemia and OSA. Promotion of healthy weights may be achieved by a multisectorial approach as recommended by the Chief Medical Officer of Health for Ontario. Bariatric surgery has a major role in morbidly obese individuals (BMI > 35 kg/m2 and a comorbid condition, or BMI > 40 kg/m2). In January 2005, the Medical Advisory Secretariat completed an assessment of bariatric surgery, based on which the Ontario Health Technology Advisory Committee recommended an improvement in access to these surgeries for morbidly obese patients in Ontario. Habitual snorers with excessive daytime sleepiness have a high pretest probability of having OSA. These patients could be offered a therapeutic trial of continuous positive airway pressure (CPAP) to diagnose OSA, rather than a PSG. A majority of these patients are also obese and may benefit from weight loss. Thus, individualized weight loss programs should be offered; patients who are morbidly obese should be offered bariatric surgery. That said, in view of the identification of OSA in the past 30 years and that the understanding of its causes, consequences and optimal treatment are still under evolution, and further research is warranted to identify which patients should be screened for OSA.

Authors' methods: Review

Project Status: Completed

Year Published: 2006

URL for published report: http://www.health.gov.on.ca/english/providers/program/mas/tech/reviews/pdf/rev_psg_060106.pdf

URL for additional information: http://www.hqontario.ca/en/mas/mas_ohtas_tech_psg_060106.html

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Canada

Organisation Name: Medical Advisory Secretariat

Contact Address: Medical Advisory Secretariat, 20 Dundas Street West, 10th Floor, Toronto, ON M5G 2N6 CANADA. Tel: 416-314-1092l; Fax: 416-325-2364;

Contact Name: MASinfo.moh@ontario.ca

Contact Email: MASinfo.moh@ontario.ca

Copyright: Medical Advisory Secretariat, Ontario Ministry of Health and Long-Term Care