Polysomnogram – no longer gold standard

Q: Hi Kent, just for my info, where is the information printed as to the PSG no longer being the gold standard?

Dr. Smith: You can read the entire medicare document here

About 35% of the way down the page, you will read this:

There is no anatomic or physiologic “gold standard” for the diagnosis of obstructive sleep apnea, in contrast to conditions such as cancer where a tissue biopsy result is the definitive standard reference. In studies that compare HST to facility-based PSG, the investigators have used the PSG result as the standard reference, i.e. the PSG result is used to define the true disease state for the individual patient. This is less than ideal since the true sensitivity and specificity of PSG in diagnosing OSA is not well documented, and this deficiency poses a practical difficulty in diagnosing OSA. Given the absence of a true “gold standard” reference, the clinical application of terms such as sensitivity and specificity is not straightforward.