Increased awareness among the general public and health care practitioners will present numerous challenges to existing health care providers and researchers who are already stretched too thin. Therefore, as described in the following sections, development and improved capacity through technology development is required.

An increased recognition of sleep disorders has resulted in an increase in demand. In a 3-year period over the late 1990s, demand for a sleep test doubled in the United States (Pack and Gurubhagavatula, 1999). In France the number of patients diagnosed and receiving continuous positive airway pressure (CPAP) treatment is annually increasing by 20 percent (Gagnadoux et al., 2002). Demand has been accompanied by improved patient access to physicians and other clinicians trained in sleep medicine and to facilities where clinical sleep tests, polysomnograms, can be performed. There are currently an estimated 1,292 sleep centers or laboratories in the United States, 39 percent of which were accredited by the American Academy of Sleep Medicine (AASM) (Tachibana et al., 2005). However, resources have not kept up with demand. For example, 80 to 90 percent of obstructive sleep apnea (OSA) cases remain undiagnosed and untreated, which increases the burden of this disorder (Kapur et al., 2002). Narcolepsy, too, is infrequently detected (Singh et al., 2005), but precise rates of under diagnosis are not available because this condition is less common. Similarly, there is poor recognition and treatment of insomnia (Benca, 2005), as well as poor communication between patient and physician. Thus, even with a growth in resources, this issue is of significant importance to the millions of individuals suffering from sleep disorders.

DEVELOPING PORTABLE DIAGNOSTIC TOOLS

Polysomnography, the “gold standard” procedure for the diagnosis of most sleep disorders, is not readily available for everyone who needs it. These procedures employ simultaneous monitoring of numerous physiological parameters including brain wave activity, eye movements, muscle activity (chin and legs), heart rate, body position, and respiratory variables, including oxygen saturation. The test is typically performed overnight in a sleep laboratory with a technician in attendance, requiring an individual to sleep in the laboratory. Thus, this procedure necessitates facilities that accommodate overnight testing (beds and monitoring areas), highly sophisticated equipment, trained staff who are willing to work night shifts, and physicians trained in sleep medicine.

Although there may currently be cost-effective ways to manage sleep disorder, the capacity does not currently exist to diagnose and treat all individuals. Most American communities do not have adequate health care resources to meet the clinical demands of treating the large number of



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