Is there a cost-effective way to diagnose mild sleep-disordered breathing?
OBJECTIVE
To determine the utility and the cost-effectiveness of oesophageal pressure, respiratory flow and movement, and oximetry (ORO) as a diagnostic tool for mild sleep-disordered breathing (SDB), as compared with overnight polysomnography (PSG).


METHODS
Seventy-nine patients evaluated for mild SDB by PSG and simultaneously by oesophageal pressure (Pes) measurement, oximetry, respiratory flow and respiratory movement on a single night. An oesophageal event (OE) was defined as irregular respiration with crescendo in Pes and rapid return to baseline with a minimal increase in the negative Pes at the end of the OE of at least 5 cm H2O or more than 50% of the baseline level. SDB was defined by ORO when oesophageal events were > 5/h, and by PSG when the respiratory disturbance index was > 5/h. The diagnostic accuracy and cost-effectiveness of ORO were compared with PSG.


RESULTS
Although the ability of ORO to detect SDB was poor: sensitivity 64%, specificity 78%, use of ORO for screening prior to PSG would have saved 5000 EUR per 100 patients compared to initial PSG.


CONCLUSIONS
Using the combination of oesophageal pressure, respiratory flow and movement and oximetry for the diagnosis of mild SDB is not cost-effective, because of its poor diagnostic accuracy. New devices having alternative means to predict arousal and respiratory effort variation should be evaluated for cost-effectiveness.
Department of Pulmonary Medicine, Helsinki University Central Hospital, Finland. adel.bachour@hus.fi
A
A
Bachour
J
J
Herrala
P
P
Maasilta
D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D006801:Humans; D008875:Middle Aged; D010092:Oximetry / Q000191:economics; D017286:Polysomnography / Q000191:economics; D012680:Sensitivity and Specificity; D012891:Sleep Apnea Syndromes / Q000175:diagnosis* / Q000191:economics