Diagnosis and initiation of nasal continuous positive airway pressure therapy for OSAS without a preceding sleep study?
OBJECTIVE
The capacity for performing sleep study is limited. We made a simulation to study whether a diagnosis of obstructive sleep apnoea syndrome (OSAS) and prescription of nasal continuous positive airway pressure (CPAP) therapy would be possible and cost-effective without performing a sleep study.


OBJECTIVE
One hundred ninety-seven consecutive patients referred to a pulmonary clinic due to suspected OSAS were included. Professional drivers, patients with neurological diseases, heart failure or aged <25 years were excluded. Two experts evaluated patient records retrospectively in a stepwise manner. In step 1, they were blinded to the sleep study results, and in step 2, the results were available.


RESULTS
Mean age was 51.5 ± 10.8 years, BMI 31.9 ± 7.2 kg/m(2), apnoea-hypopnoea index 19.8 ± 20.7/h and Epworth Sleepiness Scale 8.3 ± 4.7. Without sleep study results, the experts would initiate CPAP in 52.5% of patients (step 1), equalling to 74.7% of those whom they would suggest it after reviewing the sleep studies (step 2). In step 2, they suggested CPAP for 70.3% of all patients, while the clinicians responsible for the treatment for 66%. Net savings equal to the costs of CPAP device with interface for 50-100% of patients in need of this therapy depending on whether calculations are based on the costs of cardiorespiratory polygraphy or polysomnography.


CONCLUSIONS
Nasal CPAP therapy would be possible to initiate without a sleep study for the majority of patients with suspected OSAS resulting in significant cost reduction.
Department of Pulmonary Diseases, Turku University Hospital, Turku, Finland. ulla.anttalainen@tyks.fi
Ulla
U
Anttalainen
Kari
K
Liippo
Tarja
T
Saaresranta
D000328:Adult; D000368:Aged; D045422:Continuous Positive Airway Pressure / Q000379:methods*; D005260:Female; D005387:Finland; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D017286:Polysomnography / Q000379:methods*; D012189:Retrospective Studies; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000628:therapy*; D016896:Treatment Outcome; D019564:Unnecessary Procedures