Effectiveness of Three Sleep Apnea Management Alternatives
| Autor: | Joaquín Durán-Cantolla, Eusebi Chiner, Neus Salord, Lirios Sacristan, L. Cancelo, Carmen Monasterio, José Luis Zamorano, Jaime Corral, Alberto Alonso, Marta Cabello, Juan F. Masa, Miguel Ángel Negrín, Francisco J. Vázquez-Polo, José N. Sancho-Chust, Sanchez de Cos J, Jose M. Montserrat, Miguel Carrera, Luis Hernández-Blasco, Aizpuru F, Ricardo Mendes Pereira, Martinez A, Cristina Embid, Garcia-Ledesma E |
|---|---|
| Rok vydání: | 2013 |
| Předmět: |
Male
medicine.medical_specialty Cost effectiveness Cost-Benefit Analysis Polysomnography medicine.medical_treatment Respiratory polygraphy Physiology (medical) Internal medicine medicine Humans In patient Continuous positive airway pressure health care economics and organizations Sleep Apnea Obstructive Continuous Positive Airway Pressure medicine.diagnostic_test business.industry Sleep apnea Effectiveness of Three Sleep Apnea Management Alternatives Therapeutic decision making Middle Aged medicine.disease Home Care Services nervous system diseases respiratory tract diseases Obstructive sleep apnea Treatment Outcome Anesthesia Female Neurology (clinical) business |
| Zdroj: | Sleep. 36:1799-1807 |
| ISSN: | 1550-9109 0161-8105 |
| DOI: | 10.5665/sleep.3204 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|