title: Effectiveness of home single-channel nasal pressure for sleep apnea diagnosis.
abstract: BACKGROUND
  Home single-channel nasal pressure (HNP) may be an alternative to polysomnography (PSG) for obstructive sleep apnea (OSA) diagnosis, but no cost studies have yet been carried out. Automatic scoring is simpler but generally less effective than manual scoring.
  
  
  OBJECTIVE
  To determine the diagnostic efficacy and cost of both scorings (automatic and manual) compared with PSG, taking as a polysomnographic OSA diagnosis several apnea-hypopnea index (AHI) cutoff points.
  
  
  METHODS
  We included suspected OSA patients in a multicenter study. They were randomized to home and hospital protocols. We constructed receiver operating characteristic (ROC) curves for both scorings. Diagnostic efficacy was explored for several HNP AHI cutoff points, and costs were calculated for equally effective alternatives.
  
  
  RESULTS
  Of 787 randomized patients, 752 underwent HNP. Manual scoring produced better ROC curves than automatic for AHI < 15; similar curves were obtained for AHI ≥ 15. A valid HNP with manual scoring would determine the presence of OSA (or otherwise) in 90% of patients with a polysomnographic AHI ≥ 5 cutoff point, in 74% of patients with a polysomnographic AHI ≥ 10 cutoff point, and in 61% of patients with a polysomnographic AHI ≥ 15 cutoff point. In the same way, a valid HNP with automatic scoring would determine the presence of OSA (or otherwise) in 73% of patients with a polysomnographic AHI ≥ 5 cutoff point, in 64% of patients with a polysomnographic AHI ≥ 10 cutoff point, and in 57% of patients with a polysomnographic AHI ≥ 15 cutoff point. The costs of either HNP approaches were 40% to 70% lower than those of PSG at the same level of diagnostic efficacy. Manual HNP had the lowest cost for low polysomnographic AHI levels (≥ 5 and ≥ 10), and manual and automatic scorings had similar costs for higher polysomnographic cutoff points (AHI ≥ 15) of diagnosis.
  
  
  CONCLUSIONS
  Home single-channel nasal pressure (HNP) is a cheaper alternative than polysomnography for obstructive sleep apnea diagnosis. HNP with manual scoring seems to have better diagnostic accuracy and a lower cost than automatic scoring for patients with low apnea-hypopnea index (AHI) levels, although automatic scoring has similar diagnostic accuracy and cost as manual scoring for intermediate and high AHI levels. Therefore, automatic scoring can be appropriately used, although diagnostic efficacy could improve if we carried out manual scoring on patients with AHI < 15.
  
  
  BACKGROUND
  Clinicaltrials.gov identifier: NCT01347398.
authors.affiliation: San Pedro de Alcantara Hospital, Caceres, Spain and CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain: CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain.
authors.forename: Juan F
authors.initials: JF
authors.lastname: Masa
authors.affiliation: Bio-Araba Research Institute; Alava University Hospital, Vitoria, Spain: Department of Medicine of Basque Country University, Vitoria, 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 Pujol 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: Merche
authors.initials: M
authors.lastname: Mayos
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 University 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; Alava University Hospital, Vitoria, Spain.
authors.forename: Felipe
authors.initials: F
authors.lastname: Aizpuru
authors.affiliation: IRBLleida, 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
authors.affiliation: Centro de Medicina Respiratoria, Paraná, Argentina.
authors.forename: Luis D
authors.initials: LD
authors.lastname: Larrateguy
authors.affiliation: Clínica Angloamericana, Lima, Perú
authors.forename: Jorge Rey
authors.initials: JR
authors.lastname: de Castro
authors.affiliation: San Pedro de Alcantara Hospital, Caceres, Spain: CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain.
authors.forename: Estefania
authors.initials: E
authors.lastname: Garcia-Ledesma
authors.affiliation: San Pedro de Alcantara Hospital, Caceres, Spain: CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain.
authors.forename: Isabel
authors.initials: I
authors.lastname: Utrabo
authors.affiliation: San Pedro de Alcantara Hospital, Caceres, Spain: CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain.
authors.forename: Jaime
authors.initials: J
authors.lastname: Corral
authors.affiliation: Bio-Araba Research Institute; Alava University Hospital, Vitoria, Spain: Sleep Unit, Respiratory Department, Alava University Hospital, Vitoria, Spain: CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Martinez-Null
authors.affiliation: Bio-Araba Research Institute; Alava University Hospital, Vitoria, Spain: Sleep Unit, Respiratory Department, Alava University Hospital, Vitoria, Spain: CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Egea
authors.affiliation: Bio-Araba Research Institute; Alava University Hospital, Vitoria, Spain: Sleep Unit, Respiratory Department, Alava University Hospital, Vitoria, Spain.
authors.forename: Laura
authors.initials: L
authors.lastname: Cancelo
authors.affiliation: Virgen del Rocio Hospital, Sevilla, Spain.
authors.forename: Emilio
authors.initials: E
authors.lastname: García-Díaz
authors.affiliation: Virgen del Rocio Hospital, Sevilla, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Carmona-Bernal
authors.affiliation: Virgen del Rocio Hospital, Sevilla, Spain.
authors.forename: Angeles
authors.initials: A
authors.lastname: Sánchez-Armengol
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: Sta Creu i Sant Pau Hospital, Barcelona, Spain: CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain.
authors.forename: Rosa M
authors.initials: RM
authors.lastname: Miralda
authors.affiliation: IIS-Fundación Jimenez Diaz, Madrid, Spain.
authors.forename: Maria F
authors.initials: MF
authors.lastname: Troncoso
authors.affiliation: Valdecilla Hospital, Santander, Spain.
authors.forename: Gonzalez
authors.initials: G
authors.lastname: Monica
authors.affiliation: Valdecilla Hospital, Santander, Spain.
authors.forename: Marian
authors.initials: M
authors.lastname: Martinez-Martinez
authors.affiliation: Valdecilla Hospital, Santander, Spain.
authors.forename: Olga
authors.initials: O
authors.lastname: Cantalejo
authors.affiliation: Son Espases University Hospital, Palma de Mallorca, Spain: CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Piérola
authors.affiliation: Sabadell Hospital, Corporació Sanitària Parc Taulí, Institut Universitari Parc Tauli-UAB, Sabadell, Spain.
authors.forename: Laura
authors.initials: L
authors.lastname: Vigil
authors.affiliation: Clinic Hospital, Barcelona, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Embid
authors.affiliation: Clinic Hospital, Barcelona, Spain.
authors.forename: Mireia
authors.initials: M
authors.lastname: Del Mar Centelles
authors.affiliation: Infanta Sofía Hospital, San Sebastián de los Reyes, Madrid, Spain.
authors.forename: Teresa Ramírez
authors.initials: TR
authors.lastname: Prieto
authors.affiliation: Infanta Sofía Hospital, San Sebastián de los Reyes, Madrid, Spain.
authors.forename: Blas
authors.initials: B
authors.lastname: Rojo
authors.affiliation: Infanta Leonor Hospital, Madrid, Spain.
authors.forename: Lores
authors.initials: L
authors.lastname: Vanesa
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009666:Nose / Q000502:physiology*; D017286:Polysomnography / Q000191:economics; D011312:Pressure; D012372:ROC Curve; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000191:economics / Q000503:physiopathology*; D055815:Young Adult
keywords: Apnealink; cost-effectiveness; portable monitor; sleep apnea