Center-based vs patient-based diagnosis and therapy of sleep-related respiratory disorders and the role of the respiratory care practitioner.

Unlike center-based laboratories that follow prescribed technical standards, patient-based studies lack technical standardization. Whereas center-based studies are usually performed by technicians who have met certain professional criteria, patient-based studies can be performed by anyone, even those without clinical training. Although guidelines are currently being developed to direct the use of unattended monitoring in the home, a need exists for specific guidelines that delineate professional qualifications for those who initiate and titrate therapy for patients with sleep-related respiratory disorders. The opportunity exists for respiratory care practitioners to become involved with creating guidelines for patient monitoring and therapeutic intervention, in both center-based and patient-based settings. A need exists for multicenter, peer-reviewed, controlled studies to establish standard recording variables and machine specifications for unattended monitoring devices. Also, the role and cost-benefit ratio of unattended monitoring in healthcare delivery need to be defined. Therefore, with the demand for technology-oriented research, clinical outcome studies, and professional standards, more respiratory care practitioners have the opportunity to expand their practice into the field of sleep medicine.