Effectiveness of Three Sleep Apnea Management Alternatives
Identifieur interne : 000448 ( Main/Exploration ); précédent : 000447; suivant : 000449Effectiveness of Three Sleep Apnea Management Alternatives
Auteurs : Juan F. Masa [Espagne] ; Jaime Corral [Espagne] ; Julio Sanchez De Cos [Espagne] ; Joaquin Duran-Cantolla [Espagne] ; Marta Cabello [Espagne] ; Luis Hernández-Blasco [Espagne] ; Carmen Monasterio [Espagne] ; Alberto Alonso [Espagne] ; Eusebi Chiner [Espagne] ; Felipe Aizpuru [Espagne] ; Francisco-José Vázquez-Polo [Espagne] ; Jose Zamorano [Espagne] ; Jose M. Montserrat [Espagne] ; Estefania Garcia-Ledesma [Espagne] ; Ricardo Pereira [Espagne] ; Laura Cancelo [Espagne] ; Angeles Martinez [Espagne] ; Lirios Sacristan [Espagne] ; Neus Salord [Espagne] ; Miguel Carrera [Espagne] ; José N. Sancho-Chust [Espagne] ; Miguel A. Negrín [Espagne] ; Cristina Embid [Espagne]Source :
- Sleep [ 0161-8105 ] ; 2013.
Abstract
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.
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).
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.
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.
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.
Masa JF; Corral J; Sanchez de Cos J; Duran-Cantolla J; Cabello M; Hernández-Blasco L; Monasterio C; Alonso A; Chiner E; Aizpuru F; Vázquez-Polo FJ; Zamorano J; Montserrat JM. Effectiveness of three sleep apnea management alternatives.
Url:
DOI: 10.5665/sleep.3204
PubMed: 24293754
PubMed Central: 3825429
Affiliations:
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<affiliation wicri:level="1"><nlm:aff id="aff3">Valdecilla Hospital, Santander, Spain</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>Valdecilla Hospital, Santander</wicri:regionArea>
<wicri:noRegion>Santander</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Hernandez Blasco, Luis" sort="Hernandez Blasco, Luis" uniqKey="Hernandez Blasco L" first="Luis" last="Hernández-Blasco">Luis Hernández-Blasco</name>
<affiliation wicri:level="1"><nlm:aff id="aff4">General Universitario Hospital, Alicante, Spain</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>General Universitario Hospital, Alicante</wicri:regionArea>
<wicri:noRegion>Alicante</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Monasterio, Carmen" sort="Monasterio, Carmen" uniqKey="Monasterio C" first="Carmen" last="Monasterio">Carmen Monasterio</name>
<affiliation wicri:level="3"><nlm:aff id="aff5">Belvitge Hospital, Barcelona, Spain</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>Belvitge Hospital, Barcelona</wicri:regionArea>
<placeName><settlement type="city">Barcelone</settlement>
<region nuts="2" type="region">Catalogne</region>
</placeName>
</affiliation>
<affiliation wicri:level="3"><nlm:aff id="aff10">CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>CIBER de enfermedades respiratorias (CIBERES), Madrid</wicri:regionArea>
<placeName><settlement type="city">Madrid</settlement>
<region nuts="2" type="region">Communauté de Madrid</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Alonso, Alberto" sort="Alonso, Alberto" uniqKey="Alonso A" first="Alberto" last="Alonso">Alberto Alonso</name>
<affiliation wicri:level="1"><nlm:aff id="aff6">Son Dureta Hospital, Palma de Mallorca, Spain</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>Son Dureta Hospital, Palma de Mallorca</wicri:regionArea>
<wicri:noRegion>Palma de Mallorca</wicri:noRegion>
</affiliation>
<affiliation wicri:level="3"><nlm:aff id="aff10">CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>CIBER de enfermedades respiratorias (CIBERES), Madrid</wicri:regionArea>
<placeName><settlement type="city">Madrid</settlement>
<region nuts="2" type="region">Communauté de Madrid</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Chiner, Eusebi" sort="Chiner, Eusebi" uniqKey="Chiner E" first="Eusebi" last="Chiner">Eusebi Chiner</name>
<affiliation wicri:level="1"><nlm:aff id="aff7">San Juan Hospital, Alicante, Spain</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>San Juan Hospital, Alicante</wicri:regionArea>
<wicri:noRegion>Alicante</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Aizpuru, Felipe" sort="Aizpuru, Felipe" uniqKey="Aizpuru F" first="Felipe" last="Aizpuru">Felipe Aizpuru</name>
<affiliation wicri:level="1"><nlm:aff id="aff2">Bio-Araba Research Institute; Álava University Hospital, Vitoria, Spain</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>Bio-Araba Research Institute; Álava University Hospital, Vitoria</wicri:regionArea>
<wicri:noRegion>Vitoria</wicri:noRegion>
</affiliation>
<affiliation wicri:level="3"><nlm:aff id="aff10">CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>CIBER de enfermedades respiratorias (CIBERES), Madrid</wicri:regionArea>
<placeName><settlement type="city">Madrid</settlement>
<region nuts="2" type="region">Communauté de Madrid</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Vazquez Polo, Francisco Jose" sort="Vazquez Polo, Francisco Jose" uniqKey="Vazquez Polo F" first="Francisco-José" last="Vázquez-Polo">Francisco-José Vázquez-Polo</name>
<affiliation wicri:level="1"><nlm:aff id="aff8">Las Palmas de Gran Canaria University, Las Palmas de Gran Canaria, Spain</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>Las Palmas de Gran Canaria University, Las Palmas de Gran Canaria</wicri:regionArea>
<wicri:noRegion>Las Palmas de Gran Canaria</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Zamorano, Jose" sort="Zamorano, Jose" uniqKey="Zamorano J" first="Jose" last="Zamorano">Jose Zamorano</name>
<affiliation wicri:level="1"><nlm:aff id="aff1">San Pedro de Alcantara Hospital, Caceres, Spain</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>San Pedro de Alcantara Hospital, Caceres</wicri:regionArea>
<wicri:noRegion>Caceres</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Montserrat, Jose M" sort="Montserrat, Jose M" uniqKey="Montserrat J" first="Jose M." last="Montserrat">Jose M. Montserrat</name>
<affiliation wicri:level="3"><nlm:aff id="aff9">Clinic Hospital, Barcelona, Spain</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>Clinic Hospital, Barcelona</wicri:regionArea>
<placeName><settlement type="city">Barcelone</settlement>
<region nuts="2" type="region">Catalogne</region>
</placeName>
</affiliation>
<affiliation wicri:level="3"><nlm:aff id="aff10">CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>CIBER de enfermedades respiratorias (CIBERES), Madrid</wicri:regionArea>
<placeName><settlement type="city">Madrid</settlement>
<region nuts="2" type="region">Communauté de Madrid</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Garcia Ledesma, Estefania" sort="Garcia Ledesma, Estefania" uniqKey="Garcia Ledesma E" first="Estefania" last="Garcia-Ledesma">Estefania Garcia-Ledesma</name>
<affiliation wicri:level="1"><nlm:aff id="aff1">San Pedro de Alcantara Hospital, Caceres, Spain</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>San Pedro de Alcantara Hospital, Caceres</wicri:regionArea>
<wicri:noRegion>Caceres</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Pereira, Ricardo" sort="Pereira, Ricardo" uniqKey="Pereira R" first="Ricardo" last="Pereira">Ricardo Pereira</name>
<affiliation wicri:level="1"><nlm:aff id="aff1">San Pedro de Alcantara Hospital, Caceres, Spain</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>San Pedro de Alcantara Hospital, Caceres</wicri:regionArea>
<wicri:noRegion>Caceres</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Cancelo, Laura" sort="Cancelo, Laura" uniqKey="Cancelo L" first="Laura" last="Cancelo">Laura Cancelo</name>
<affiliation wicri:level="1"><nlm:aff id="aff2">Bio-Araba Research Institute; Álava University Hospital, Vitoria, Spain</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>Bio-Araba Research Institute; Álava University Hospital, Vitoria</wicri:regionArea>
<wicri:noRegion>Vitoria</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Martinez, Angeles" sort="Martinez, Angeles" uniqKey="Martinez A" first="Angeles" last="Martinez">Angeles Martinez</name>
<affiliation wicri:level="1"><nlm:aff id="aff3">Valdecilla Hospital, Santander, Spain</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>Valdecilla Hospital, Santander</wicri:regionArea>
<wicri:noRegion>Santander</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Sacristan, Lirios" sort="Sacristan, Lirios" uniqKey="Sacristan L" first="Lirios" last="Sacristan">Lirios Sacristan</name>
<affiliation wicri:level="1"><nlm:aff id="aff4">General Universitario Hospital, Alicante, Spain</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>General Universitario Hospital, Alicante</wicri:regionArea>
<wicri:noRegion>Alicante</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Salord, Neus" sort="Salord, Neus" uniqKey="Salord N" first="Neus" last="Salord">Neus Salord</name>
<affiliation wicri:level="3"><nlm:aff id="aff5">Belvitge Hospital, Barcelona, Spain</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>Belvitge Hospital, Barcelona</wicri:regionArea>
<placeName><settlement type="city">Barcelone</settlement>
<region nuts="2" type="region">Catalogne</region>
</placeName>
</affiliation>
<affiliation wicri:level="3"><nlm:aff id="aff10">CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>CIBER de enfermedades respiratorias (CIBERES), Madrid</wicri:regionArea>
<placeName><settlement type="city">Madrid</settlement>
<region nuts="2" type="region">Communauté de Madrid</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Carrera, Miguel" sort="Carrera, Miguel" uniqKey="Carrera M" first="Miguel" last="Carrera">Miguel Carrera</name>
<affiliation wicri:level="1"><nlm:aff id="aff6">Son Dureta Hospital, Palma de Mallorca, Spain</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>Son Dureta Hospital, Palma de Mallorca</wicri:regionArea>
<wicri:noRegion>Palma de Mallorca</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Sancho Chust, Jose N" sort="Sancho Chust, Jose N" uniqKey="Sancho Chust J" first="José N." last="Sancho-Chust">José N. Sancho-Chust</name>
<affiliation wicri:level="1"><nlm:aff id="aff7">San Juan Hospital, Alicante, Spain</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>San Juan Hospital, Alicante</wicri:regionArea>
<wicri:noRegion>Alicante</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Negrin, Miguel A" sort="Negrin, Miguel A" uniqKey="Negrin M" first="Miguel A." last="Negrín">Miguel A. Negrín</name>
<affiliation wicri:level="1"><nlm:aff id="aff8">Las Palmas de Gran Canaria University, Las Palmas de Gran Canaria, Spain</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>Las Palmas de Gran Canaria University, Las Palmas de Gran Canaria</wicri:regionArea>
<wicri:noRegion>Las Palmas de Gran Canaria</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Embid, Cristina" sort="Embid, Cristina" uniqKey="Embid C" first="Cristina" last="Embid">Cristina Embid</name>
<affiliation wicri:level="3"><nlm:aff id="aff9">Clinic Hospital, Barcelona, Spain</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>Clinic Hospital, Barcelona</wicri:regionArea>
<placeName><settlement type="city">Barcelone</settlement>
<region nuts="2" type="region">Catalogne</region>
</placeName>
</affiliation>
</author>
</analytic>
<series><title level="j">Sleep</title>
<idno type="ISSN">0161-8105</idno>
<idno type="eISSN">1550-9109</idno>
<imprint><date when="2013">2013</date>
</imprint>
</series>
</biblStruct>
</sourceDesc>
</fileDesc>
<profileDesc><textClass></textClass>
</profileDesc>
</teiHeader>
<front><div type="abstract" xml:lang="en"><sec><title>Rationale:</title>
<p>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.</p>
</sec>
<sec><title>Objectives:</title>
<p>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).</p>
</sec>
<sec><title>Methods:</title>
<p>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.</p>
</sec>
<sec><title>Results:</title>
<p>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.</p>
</sec>
<sec><title>Conclusion:</title>
<p>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.</p>
</sec>
<sec><title>Citation:</title>
<p>Masa JF; Corral J; Sanchez de Cos J; Duran-Cantolla J; Cabello M; Hernández-Blasco L; Monasterio C; Alonso A; Chiner E; Aizpuru F; Vázquez-Polo FJ; Zamorano J; Montserrat JM. Effectiveness of three sleep apnea management alternatives. <italic>SLEEP</italic>
2013;36(12):1799-1807.</p>
</sec>
</div>
</front>
</TEI>
<affiliations><list><country><li>Espagne</li>
</country>
<region><li>Catalogne</li>
<li>Communauté de Madrid</li>
</region>
<settlement><li>Barcelone</li>
<li>Madrid</li>
</settlement>
</list>
<tree><country name="Espagne"><noRegion><name sortKey="Masa, Juan F" sort="Masa, Juan F" uniqKey="Masa J" first="Juan F." last="Masa">Juan F. Masa</name>
</noRegion>
<name sortKey="Aizpuru, Felipe" sort="Aizpuru, Felipe" uniqKey="Aizpuru F" first="Felipe" last="Aizpuru">Felipe Aizpuru</name>
<name sortKey="Aizpuru, Felipe" sort="Aizpuru, Felipe" uniqKey="Aizpuru F" first="Felipe" last="Aizpuru">Felipe Aizpuru</name>
<name sortKey="Alonso, Alberto" sort="Alonso, Alberto" uniqKey="Alonso A" first="Alberto" last="Alonso">Alberto Alonso</name>
<name sortKey="Alonso, Alberto" sort="Alonso, Alberto" uniqKey="Alonso A" first="Alberto" last="Alonso">Alberto Alonso</name>
<name sortKey="Cabello, Marta" sort="Cabello, Marta" uniqKey="Cabello M" first="Marta" last="Cabello">Marta Cabello</name>
<name sortKey="Cancelo, Laura" sort="Cancelo, Laura" uniqKey="Cancelo L" first="Laura" last="Cancelo">Laura Cancelo</name>
<name sortKey="Carrera, Miguel" sort="Carrera, Miguel" uniqKey="Carrera M" first="Miguel" last="Carrera">Miguel Carrera</name>
<name sortKey="Chiner, Eusebi" sort="Chiner, Eusebi" uniqKey="Chiner E" first="Eusebi" last="Chiner">Eusebi Chiner</name>
<name sortKey="Corral, Jaime" sort="Corral, Jaime" uniqKey="Corral J" first="Jaime" last="Corral">Jaime Corral</name>
<name sortKey="Corral, Jaime" sort="Corral, Jaime" uniqKey="Corral J" first="Jaime" last="Corral">Jaime Corral</name>
<name sortKey="Duran Cantolla, Joaquin" sort="Duran Cantolla, Joaquin" uniqKey="Duran Cantolla J" first="Joaquin" last="Duran-Cantolla">Joaquin Duran-Cantolla</name>
<name sortKey="Duran Cantolla, Joaquin" sort="Duran Cantolla, Joaquin" uniqKey="Duran Cantolla J" first="Joaquin" last="Duran-Cantolla">Joaquin Duran-Cantolla</name>
<name sortKey="Embid, Cristina" sort="Embid, Cristina" uniqKey="Embid C" first="Cristina" last="Embid">Cristina Embid</name>
<name sortKey="Garcia Ledesma, Estefania" sort="Garcia Ledesma, Estefania" uniqKey="Garcia Ledesma E" first="Estefania" last="Garcia-Ledesma">Estefania Garcia-Ledesma</name>
<name sortKey="Hernandez Blasco, Luis" sort="Hernandez Blasco, Luis" uniqKey="Hernandez Blasco L" first="Luis" last="Hernández-Blasco">Luis Hernández-Blasco</name>
<name sortKey="Martinez, Angeles" sort="Martinez, Angeles" uniqKey="Martinez A" first="Angeles" last="Martinez">Angeles Martinez</name>
<name sortKey="Masa, Juan F" sort="Masa, Juan F" uniqKey="Masa J" first="Juan F." last="Masa">Juan F. Masa</name>
<name sortKey="Monasterio, Carmen" sort="Monasterio, Carmen" uniqKey="Monasterio C" first="Carmen" last="Monasterio">Carmen Monasterio</name>
<name sortKey="Monasterio, Carmen" sort="Monasterio, Carmen" uniqKey="Monasterio C" first="Carmen" last="Monasterio">Carmen Monasterio</name>
<name sortKey="Montserrat, Jose M" sort="Montserrat, Jose M" uniqKey="Montserrat J" first="Jose M." last="Montserrat">Jose M. Montserrat</name>
<name sortKey="Montserrat, Jose M" sort="Montserrat, Jose M" uniqKey="Montserrat J" first="Jose M." last="Montserrat">Jose M. Montserrat</name>
<name sortKey="Negrin, Miguel A" sort="Negrin, Miguel A" uniqKey="Negrin M" first="Miguel A." last="Negrín">Miguel A. Negrín</name>
<name sortKey="Pereira, Ricardo" sort="Pereira, Ricardo" uniqKey="Pereira R" first="Ricardo" last="Pereira">Ricardo Pereira</name>
<name sortKey="Sacristan, Lirios" sort="Sacristan, Lirios" uniqKey="Sacristan L" first="Lirios" last="Sacristan">Lirios Sacristan</name>
<name sortKey="Salord, Neus" sort="Salord, Neus" uniqKey="Salord N" first="Neus" last="Salord">Neus Salord</name>
<name sortKey="Salord, Neus" sort="Salord, Neus" uniqKey="Salord N" first="Neus" last="Salord">Neus Salord</name>
<name sortKey="Sanchez De Cos, Julio" sort="Sanchez De Cos, Julio" uniqKey="Sanchez De Cos J" first="Julio" last="Sanchez De Cos">Julio Sanchez De Cos</name>
<name sortKey="Sanchez De Cos, Julio" sort="Sanchez De Cos, Julio" uniqKey="Sanchez De Cos J" first="Julio" last="Sanchez De Cos">Julio Sanchez De Cos</name>
<name sortKey="Sancho Chust, Jose N" sort="Sancho Chust, Jose N" uniqKey="Sancho Chust J" first="José N." last="Sancho-Chust">José N. Sancho-Chust</name>
<name sortKey="Vazquez Polo, Francisco Jose" sort="Vazquez Polo, Francisco Jose" uniqKey="Vazquez Polo F" first="Francisco-José" last="Vázquez-Polo">Francisco-José Vázquez-Polo</name>
<name sortKey="Zamorano, Jose" sort="Zamorano, Jose" uniqKey="Zamorano J" first="Jose" last="Zamorano">Jose Zamorano</name>
</country>
</tree>
</affiliations>
</record>
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