title: Effectiveness of three sleep apnea management alternatives.
abstract: BACKGROUND
  Home respiratory polygraphy (HRP) may be a cost-effective alternative to polysomnography (PSG) for diagnosis and treatment election in patients with high clinical probability of obstructive sleep apnea (OSA), but there is conflicting evidence on its use for a wider spectrum of patients.
  
  
  OBJECTIVE
  To determine the efficacy and cost of OSA management (diagnosis and therapeutic decision making) using (1) PSG for all patients (PSG arm); (2) HRP for all patients (HRP arm); and (3) HRP for a subsample of patients with high clinical probability of being treated with continuous positive airway pressure (CPAP) and PSG for the remainder (elective HRP arm).
  
  
  METHODS
  Multicentric study of 366 patients with intermediate-high clinical probability of OSA, randomly subjected to HRP and PSG. We explored the diagnostic and therapeutic decision agreements between the PSG and both HRP arms for several HRP cutoff points and calculated costs for equal diagnostic and/or therapeutic decision efficacy.
  
  
  RESULTS
  For equal diagnostic and therapeutic decision efficacy, PSG arm costs were 18% higher than HRP arm costs and 20% higher than elective HRP arm costs. HRP arm costs tended to be lower than elective HRP arm costs, and both tended to be lower than PSG arm costs if patient costs were omitted.
  
  
  CONCLUSIONS
  Home respiratory polygraphy is a less costly alternative than polysomnography for the diagnosis and therapeutic decision making for patients with suspected obstructive sleep apnea. We found no advantage in cost terms, however, in using home respiratory polygraphy for all patients or home respiratory polygraphy for the most symptomatic patients and polysomnography for the rest.
authors.affiliation: San Pedro de Alcantara Hospital, Caceres, Spain ; CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain.
authors.forename: Juan F
authors.initials: JF
authors.lastname: Masa
authors.forename: Jaime
authors.initials: J
authors.lastname: Corral
authors.forename: Julio
authors.initials: J
authors.lastname: Sanchez de Cos
authors.forename: Joaquin
authors.initials: J
authors.lastname: Duran-Cantolla
authors.forename: Marta
authors.initials: M
authors.lastname: Cabello
authors.forename: Luis
authors.initials: L
authors.lastname: Hernández-Blasco
authors.forename: Carmen
authors.initials: C
authors.lastname: Monasterio
authors.forename: Alberto
authors.initials: A
authors.lastname: Alonso
authors.forename: Eusebi
authors.initials: E
authors.lastname: Chiner
authors.forename: Felipe
authors.initials: F
authors.lastname: Aizpuru
authors.forename: Francisco-José
authors.initials: FJ
authors.lastname: Vázquez-Polo
authors.forename: Jose
authors.initials: J
authors.lastname: Zamorano
authors.forename: Jose M
authors.initials: JM
authors.lastname: Montserrat
authors.forename: Estefania
authors.initials: E
authors.lastname: Garcia-Ledesma
authors.forename: Ricardo
authors.initials: R
authors.lastname: Pereira
authors.forename: Laura
authors.initials: L
authors.lastname: Cancelo
authors.forename: Angeles
authors.initials: A
authors.lastname: Martinez
authors.forename: Lirios
authors.initials: L
authors.lastname: Sacristan
authors.forename: Neus
authors.initials: N
authors.lastname: Salord
authors.forename: Miguel
authors.initials: M
authors.lastname: Carrera
authors.forename: José N
authors.initials: JN
authors.lastname: Sancho-Chust
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Negrín
authors.forename: Cristina
authors.initials: C
authors.lastname: Embid
mesh_terms: D045422:Continuous Positive Airway Pressure / Q000379:methods; D003362:Cost-Benefit Analysis; D005260:Female; D006699:Home Care Services / Q000191:economics; D006801:Humans; D008297:Male; D008875:Middle Aged; D017286:Polysomnography / Q000191:economics / Q000379:methods*; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000191:economics / Q000628:therapy*; D016896:Treatment Outcome
keywords: Cost efficacy; home respiratory polygraphy; portable monitor; sleep apnea