title: The challenge of undiagnosed sleep apnea in low-risk populations: a decision analysis.
abstract: OBJECTIVE
  Obstructive sleep apnea (OSA) may contribute to impaired performance among otherwise healthy active duty military personnel. We used decision analysis to evaluate three approaches to identifying and treating OSA in low-risk populations, which may differ from current standard practice for high-risk populations.
  
  
  METHODS
  We developed a decision tree to compare two simple strategies for diagnosis and management of sleep apnea in a low-risk population. In one strategy, a simple screening inventory was followed by conventional laboratory polysomnography (split-night), whereas the alternative strategy involved performing home testing in all individuals. This allowed us to weigh the costs associated with large-scale diagnostic approaches against the costs of untreated OSA in a small fraction of the population.
  
  
  RESULTS
  We found that the home testing approach was less expensive than the screen-then-test approach across a broad range of other important parameters, including the annual performance cost associated with untreated OSA, the prevalence of OSA, and the duration of active duty.
  
  
  CONCLUSIONS
  Assuming even modest annual performance costs associated with untreated OSA, a population strategy involving large-scale home testing is less expensive than a screening inventory approach. These results may inform either targeted or large-scale investigation of undiagnosed OSA in low-risk populations such as active duty military.
authors.affiliation: Neurology Department, 55 Fruit Street, Wang 720, MGH Neurology, Boston, MA 02114.
authors.forename: Matt T
authors.initials: MT
authors.lastname: Bianchi
authors.affiliation: Systems Biology Graduate Program, Harvard Medical School, 200 Longwood Avenue, Alpert 536, Boston, MA 02115.
authors.forename: Steven
authors.initials: S
authors.lastname: Hershman
authors.affiliation: Harvard School of Dental Medicine, 188 Longwood Avenue, Boston, MA 02115.
authors.forename: Mahshid
authors.initials: M
authors.lastname: Bahadoran
authors.affiliation: Neurology Department, 55 Fruit Street, Wang 720, MGH Neurology, Boston, MA 02114.
authors.forename: Matthew
authors.initials: M
authors.lastname: Ferguson
authors.affiliation: Neurology Department, 55 Fruit Street, Wang 720, MGH Neurology, Boston, MA 02114.
authors.forename: M Brandon
authors.initials: MB
authors.lastname: Westover
mesh_terms: D045422:Continuous Positive Airway Pressure / Q000191:economics; D003661:Decision Support Techniques; D003663:Decision Trees; D004526:Efficiency; D006801:Humans; D008403:Mass Screening / Q000191:economics; D008889:Military Personnel; D018670:Monitoring, Ambulatory / Q000191:economics; D017286:Polysomnography / Q000191:economics; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000191:economics / Q000628:therapy*; D014481:United States
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