title: Efficacy of home single-channel nasal pressure for recommending continuous positive airway pressure treatment in sleep apnea.
abstract: BACKGROUND
  Unlike other prevalent diseases, obstructive sleep apnea (OSA) has no simple tool for diagnosis and therapeutic decision-making in primary healthcare. Home single-channel nasal pressure (HNP) may be an alternative to polysomnography for diagnosis but its use in therapeutic decisions has yet to be explored.
  
  
  OBJECTIVE
  To ascertain whether an automatically scored HNP apnea-hypopnea index (AHI), used alone to recommend continuous positive airway pressure (CPAP) treatment, agrees with decisions made by a specialist using polysomnography and several clinical variables.
  
  
  METHODS
  Patients referred by primary care physicians for OSA suspicion underwent randomized polysomnography and HNP. We analyzed the total sample and both more and less symptomatic subgroups for Bland and Altman plots to explore AHI agreement; receiver operating characteristic curves to establish area under the curve (AUC) measurements for CPAP recommendation; and therapeutic decision efficacy for several HNP AHI cutoff points.
  
  
  RESULTS
  Of the 787 randomized patients, 35 (4%) were lost, 378 (48%) formed the more symptomatic and 374 (48%) the less symptomatic subgroups. AHI bias and agreement limits were 5.8 ± 39.6 for the total sample, 5.3 ± 38.7 for the more symptomatic, and 6 ± 40.2 for the less symptomatic subgroups. The AUC were 0.826 for the total sample, 0.903 for the more symptomatic, and 0.772 for the less symptomatic subgroups. In the more symptomatic subgroup, 70% of patients could be correctly treated with CPAP.
  
  
  CONCLUSIONS
  Automatic HNP scoring can correctly recommend CPAP treatment in most of more symptomatic patients with OSA suspicion. Our results suggest that this device may be an interesting tool in initial OSA management for primary care physicians, although future studies in a primary care setting are necessary.
  
  
  BACKGROUND
  Clinicaltrial.gov identifier: NCT01347398.
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.affiliation: Bio-Araba Research Institute, Vitoria-Gasteiz, Spain; Alava University Hospital: Department of Medicine of Basque Country University, Spain: CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain.
authors.forename: Joaquin
authors.initials: J
authors.lastname: Duran-Cantolla
authors.affiliation: Virgen del Rocio Hospital, Sevilla, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Capote
authors.affiliation: Valdecilla Hospital, Santander, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Cabello
authors.affiliation: Germans Trials i Pujos Hospital, Barcelona, Spain: CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain.
authors.forename: Jorge
authors.initials: J
authors.lastname: Abad
authors.affiliation: La Paz Hospital, IdiPAZ, Madrid, Spain: CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Garcia-Rio
authors.affiliation: Sabadell Hospital, Corporació Sanitària Parc Taulí, Institut Universitari Parc Tauli-UAB, Sabadell, Spain: CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain.
authors.forename: Antoni
authors.initials: A
authors.lastname: Ferrer
authors.affiliation: Sta Creu i Sant Pau Hospital, Barcelona, Spain: CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain.
authors.forename: Ana M
authors.initials: AM
authors.lastname: Fortuna
authors.affiliation: IIS-Fundación Jimenez Diaz, Madrid, Spain: CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Gonzalez-Mangado
authors.affiliation: Son Espases Universitary Hospital, Palma de Mallorca, Spain: CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain.
authors.forename: Monica
authors.initials: M
authors.lastname: de la Peña
authors.affiliation: Bio-Araba Research Institute, Vitoria-Gasteiz, Spain; Alava University Hospital.
authors.forename: Felipe
authors.initials: F
authors.lastname: Aizpuru
authors.affiliation: IRB Lleida, Lleida, Spain: CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain.
authors.forename: Ferran
authors.initials: F
authors.lastname: Barbe
authors.affiliation: Clinic Hospital, Barcelona, Spain: CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain.
authors.forename: Jose M
authors.initials: JM
authors.lastname: Montserrat
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D045422:Continuous Positive Airway Pressure; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009666:Nose / Q000502:physiology*; D017286:Polysomnography; D011312:Pressure; D012372:ROC Curve; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D055815:Young Adult
keywords: Apnealink; CPAP; portable monitor; sleep apnea