Sleep-disordered breathing: Diagnosis

Obstructive sleep apnea (OSA) is a heterogeneous disease with many physiological implications and is highly prevalent in both children and adults. The diagnosis of OSA requires a high index of suspicion. In this regard, the diagnostic strategy includes a sleep-oriented history, physical examination, and objective testing. It is very important to make a reliable definitive diagnosis to avoid adverse health consequences, especially in moderate or severe cases. To conclusively establish the presence and severity of OSA in symptomatic patients, in-laboratory polysomnography (PSG) is the gold standard method. Nevertheless, as such test is a complex, onerous, labor intensive, and time-consuming process both for the patient and for the professionals involved in the process, automated decision support systems have emerged in the last few years to overcome the limitations of standard protocols and conventional approaches for OSA detection. In this chapter, the diagnostic procedures for OSA diagnosis in children and adults are summarized. The usefulness of history and physical examination as well as OSA questionnaires for the detection of patients with high risk for the disease is analyzed. Next, comprehensive sleep studies from complete PSG to abbreviated home sleep apnea testing (HSAT) are characterized, and recent recommendations regarding respiratory events detection and sleep staging from major sleep medicine societies are detailed. Finally, recent advances of artificial intelligence and machine learning in the context of OSA diagnosis are reviewed.