Should patients with sleep apnoea/hypopnoea syndrome be diagnosed and managed on the basis of home sleep studies?
The purpose of this study was to analyse the validity and the economic efficiency of a portable monitor of respiratory parameters (PMRP), used in a home setting for the diagnosis of sleep apnoea/hypopnoea syndrome (SAHS). Eighty nine patients with suspected SAHS were studied in two settings: in the sleep laboratory using full-polysomnography (full-PSG); and at the patient's home using a PMRP. In the home setting, 50 patients were assisted by a technician and 39 set up the equipment themselves. SAHS (apnoea/hypopnoea index (AHI) >10 events x h(-1) by means of full-PSG) was diagnosed in 75 of the 89 patients. An acceptable agreement was obtained between the AHI measured by full-PSG and PMRP, according to the Bland and Altman method of concordance (mean bias 2.56; 95% confidence interval 3.25). Sensitivity and specificity of PMRP were adequate for diagnostic purposes; however, their values rely on the prior PMRP-AHI cut-off point selected with reference to full-PSG-AHI >10. The clinical therapeutic decision taken after PMRP agreed with that taken with full-PSG in 79 patients (89%). Although 10% of the studies with an individual set-up needed repetition, both of the domiciliary modalities (with and without a technician's intervention) were, economically, about three times more efficient than full-PSG. In conclusion, we believe that patients with a suspected sleep apnoea/hypopnoea syndrome should initially be studied in a home setting with a portable monitor of respiratory parameters, since it is a reliable method with an acceptable cost-effective profile.
Parra
O
O
Servei de Pneumologia, Hospitals de Barcelona (Quinta Salut Alianca), Spain.
García-Esclasans
N
N
Montserrat
J M
JM
García Eroles
L
L
Ruíz
J
J
López
J A
JA
Guerra
J M
JM
Sopeña
J J
JJ
D000328:Adult; D005069:Evaluation Studies as Topic; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D017286:Polysomnography / Q000191:economics / Q000295:instrumentation / Q000379:methods; D012372:ROC Curve; D012120:Respiration Disorders / Q000175:diagnosis* / Q000628:therapy*; D012648:Self Care; D012891:Sleep Apnea Syndromes / Q000175:diagnosis* / Q000628:therapy*; D013577:Syndrome