These clinical guidelines, which have been reviewed and approved by the Board of Directors of the American
Sleep Disorders Association, provide recommendations for the practice of sleep medicine in North America regarding the indications for polysomnography in the diagnosis of
sleep disorders. Diagnostic categories that are considered include the following: sleep-related breathing disorders; neuromuscular disorders and sleep-related symptoms; chronic
lung disease;
narcolepsy;
parasomnias; sleep-related
epilepsy;
restless legs syndrome;
periodic limb movement disorder; depression with
insomnia; and
circadian rhythm sleep disorders. Whenever possible, conclusions are based on evidence from review of the literature. Where scientific data are absent, insufficient, or inconclusive, recommendations are based on consensus of opinion. The Standards of Practice Committee of the American
Sleep Disorders Association appointed a task force to review the topic, the indications for polysomnography and related procedures. Based on the review and on consultation with specialists, the subsequent recommendations were developed by the Standards of Practice Committee and approved by the Board of Directors of the American
Sleep Disorders Association. Polysomnography is routinely indicated for the diagnosis of sleep-related breathing disorders; for
continuous positive airway pressure (CPAP) titration in patients with sleep-related breathing disorders; for documenting the presence of
obstructive sleep apnea in patients prior to
laser-assisted uvulopalatopharyngoplasty; for the assessment of treatment results in some cases; with a multiple sleep latency test in the evaluation of suspected
narcolepsy; in evaluating sleep-related behaviors that are violent or otherwise potentially injurious to the patient or others; and in certain atypical or unusual
parasomnias. Polysomnography may be indicated in patients with neuromuscular disorders and sleep-related symptoms; to assist in with the diagnosis of paroxysmal arousals or other sleep disruptions thought to be seizure-related; in a presumed
parasomnia or sleep-related
epilepsy that does not respond to conventional
therapy; or when there is a strong clinical suspicion of
periodic limb movement disorder. Polysomnography is not routinely indicated to diagnose chronic
lung disease; in cases of typical, uncomplicated, and noninjurious
parasomnias when the diagnosis is clearly delineated; for patients with
epilepsy who have no specific complaints consistent with a
sleep disorder; to diagnose or treat
restless legs syndrome; for the diagnosis of
circadian rhythm sleep disorders; or to establish a diagnosis of depression.