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Title: Effectiveness of three sleep apnea management alternatives
Authors: Masa, Juan F.
Corral, Jaime
De Cos, Julio Sanchez
Duran-Cantolla, Joaquin
Cabello, Marta
Hernández-Blasco, Luis
Monasterio, Carmen
Alonso, Alberto
Chiner, Eusebi
Aizpuru, Felipe
Vázquez-Polo, Francisco José 
Zamorano, Jose
Montserrat, Jose M.
Garcia-Ledesma, Estefania
Pereira, Ricardo
Cancelo, Laura
Martinez, Angeles
Sacristan, Lirios
Salord, Neus
Carrera, Miguel
Sancho-Chust, José N.
Negrín, Miguel A. 
Embid, Cristina
Keywords: Home Respiratory Polygraphy
Positive Airway Pressure
Randomized Controlled-Trial
Hypopnea Syndrome
Apnoea/Hypopnoea Syndrome, et al
Issue Date: 2013
Publisher: 0161-8105
Journal: Sleep 
Abstract: Rationale: 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.Objectives: 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.Conclusion: 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.
ISSN: 0161-8105
DOI: 10.5665/sleep.3204
Source: Sleep[ISSN 0161-8105],v. 36, p. 1799-1807
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