SESSION TITLE: OSA Posters
SESSION TYPE: Poster Presentations
PRESENTED ON: Saturday, March 22, 2014 at 01:15 PM - 02:15 PM
PURPOSE: Home single-channel nasal pressure (HNP) may be an alternative to polysomnography (PSG) for obstructive sleep apnea (OSA) diagnosis but no cost studies have been carried out. Automatic scoring is simpler but generally less effective than manual scoring. Objectives: To determine the diagnostic efficacy and cost of both scorings (automatic and manual) compared with PSG, taking as a polysomnographic OSA diagnosis a clinical-epidemiological apnea-hypopnea index (AHI) cut-off point (≥5) and a clinical-therapeutic AHI cut-off point (≥15).
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 cut-off 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≥5 and similar for AHI≥15. A valid HNP would correctly classify the OSA presence (or otherwise) with manual scoring for a clinical-epidemiological diagnosis in 90% of patients and with automatic scoring for a clinical-therapeutic diagnosis in 60%. The costs of either HNP approach were 40%-70% lower than those of PSG. Manual HNP for clinical-epidemiological diagnosis had the lowest cost and manual and automatic scorings had similar costs for clinical-therapeutic diagnosis.
CONCLUSIONS: HNP is a cheaper alternative than PSG for OSA diagnosis. Manual HNP scoring seems especially useful for epidemiological studies on a clinical population base, although manual or automatic scorings can achieve a suitable diagnosis for clinical-therapeutic management
CLINICAL IMPLICATIONS: The use of a very simple automatic device favor the use for non-specialist practitioners for the management of patients with sleep apnea suspicion
DISCLOSURE: The following authors have nothing to disclose: Juan F. Masa, Joaquín Durán-Cantolla, Francisco Capote, Marta Cabello, Jorge Abad, Francisco Garcia-Rio, Antoni Ferrer, Merche Mayos, Nicolás Mangado, Mónica de la Peña, Felipe Aizpuru, Ferran Barbé, Jose M. Montserrat
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