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Diagnosis, Cost, and Therapeutic Decision-Making of Home Respiratory Poligraphy for Patients Without High Suspicion of OSA or With Comorbidity: Hospital Polysomography in Comparison With Three Nights of Home Respiratory Polygraphy FREE TO VIEW

Arnoldo Guerrero, MD; Juan F. Masa, PhD; Cristina Embid, PhD; Jose M. Montserrat, PhD
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Hospital Clinic, Barcelona, Spain

Chest. 2014;145(3_MeetingAbstracts):572A. doi:10.1378/chest.1836094
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SESSION TITLE: Sleep Posters

SESSION TYPE: Poster Presentations

PRESENTED ON: Saturday, March 22, 2014 at 01:15 PM - 02:15 PM

PURPOSE: Obstructive Sleep Apnea (OSA) diagnosis by using simplied methods such as home respiratory polygraphy (HRP) are only recommended in patients with a high pre-test probability. At present patients without high pretest probability or with co-morbidity are even more prevalent and other diagnosis approaches than to polysomnography (PSG) are needed. Three consecutive HRP may be useful.

METHODS: Randomized, blinded, crossover study of three nights of HRP (3N-HRP) vs PSG. The diagnostic efficacy was evaluated with ROC curves at different PSG apnea hypopnea-index (AHI) cut-off points. Therapeutic decisions to assess concordance between the two different approaches were analyzed by sleep physicians but also by respiratory physicians (staff and residents) using agreement level and Cohen's weighted kappa coefficient. The costs of the each diagnostic strategy were considered in an analysis of two equally effective alternatives.

RESULTS: Fifty-six patients were selected. Mean Epworth sleepiness scale 10.2 (5.3) points. Bland Altman plot for AHI show good agreement. ROC curves shows the best AUC in patients with AHI ≥ 5, [0.955 (CI= 0.862 to 0.993)]. An AHI < 5 from HRP effectively would exclude OSA diagnosis. For a PSG AHI > 15 an HRP AHI > 22 from HRP confirm the disease. The best agreement of therapeutic decisions was achieved by the sleep medicine specialists (81.8%). The costs-efficacy of the diagnosis procedure of 3N-HRP is better.

CONCLUSIONS: Three nights of HRP in conjunction with a comprehensive evaluation by a qualified sleep specialist allows a cost-effective diagnosis and therapeutic recommendation in patients without high pretest probability of OSA or those with co-morbidities when the 3N-HRP AHI is high

CLINICAL IMPLICATIONS: The results of our study suggest that 3N-HRP is useful for confirming or excluding the diagnosis of OSA in patients with a low pre-test probability of sleep apnea or with co-morbidities that can mimic or mask the symptoms of OSA or could impede an adequate sleep time. The therapeutic decisions were more consistent when were made by sleep specialists which is consistent with the AASM recommendations. 3N-HRP is less costly than full PSG for equal diagnostic efficacy.

DISCLOSURE: The following authors have nothing to disclose: Arnoldo Guerrero, Juan F. Masa, Cristina Embid, Jose M. Montserrat

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