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Title: Effectiveness of sequential automaticmanual home respiratory polygraphy scoring
Authors: Masa, Juan F.
Corral, Jaime
Pereira, Ricardo
Duran-Cantolla, Joaquin
Cabello, Marta
Hernández-Blasco, Luis
Monasterio, Carmen
Alonso-Fernandez, Alberto
Chiner, Eusebi
Francisco-José Vázquez-Polo 
Jose, M. Montserrat
UNESCO Clasification: 32 Ciencias médicas
320508 Enfermedades pulmonares
Keywords: Obstructive Sleep-Apnea
Positive Airway Pressure
Hypopnea, et al
Issue Date: 2013
Publisher: 0903-1936
Journal: European Respiratory Journal 
Abstract: Automatic home respiratory polygraphy (HRP) scoring functions can potentially confirm the diagnosis of sleep apnoea-hypopnoea syndrome (SAHS) (obviating technician scoring) in a substantial number of patients. The result would have important management and cost implications. The aim of this study was to determine the diagnostic cost-effectiveness of a sequential HRP scoring protocol (automatic and then manual for residual cases) compared with manual HRP scoring, and with in-hospital polysomnography.We included suspected SAHS patients in a multicentre study and assigned them to home and hospital protocols at random. We constructed receiver operating characteristic (ROC) curves for manual and automatic scoring. Diagnostic agreement for several cut-off points was explored and costs for two equally effective alternatives were calculated.Of 366 randomised patients, 348 completed the protocol. Manual scoring produced better ROC curves than automatic scoring. There was no sensitive automatic or subsequent manual HRP apnoea-hypopnoea index (AHI) cut-off point. The specific cut-off points for automatic and subsequent manual HRP scorings (AHI >25 and >20, respectively) had a specificity of 93% for automatic and 94% for manual scorings. The costs of manual protocol were 9% higher than sequential HRP protocol; these were 69% and 64%, respectively, of the cost of the polysomnography.A sequential HRP scoring protocol is a cost-effective alternative to polysomnography, although with limited cost savings compared to HRP manual scoring.
ISSN: 0903-1936
DOI: 10.1183/09031936.00186811
Source: European Respiratory Journal[ISSN 0903-1936],v. 41, p. 879-887
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