Cost-effectiveness Analysis of Preoperative Screening Strategies for Obstructive Sleep Apnea among Patients Undergoing Elective Inpatient Surgery.

BACKGROUND: Obstructive sleep apnea is underdiagnosed in surgical patients. The cost-effectiveness of obstructive sleep apnea screening is unknown. This study's objective was to evaluate the cost-effectiveness of preoperative obstructive sleep apnea screening (1) perioperatively and (2) including patients' remaining lifespans. METHODS: An individual-level Markov model was constructed to simulate the perioperative period and lifespan of patients undergoing inpatient elective surgery. Costs (2016 Canadian dollars) were calculated from the hospital perspective in a single-payer health system. Remaining model parameters were derived from a structured literature search. Candidate strategies included: (1) no screening; (2) STOP-Bang questionnaire alone; (3) STOP-Bang followed by polysomnography (STOP-Bang + polysomnography); and (4) STOP-Bang followed by portable monitor (STOP-Bang + portable monitor). Screen-positive patients (based on STOP-Bang cutoff of at least 3) received postoperative treatment modifications and expedited definitive testing. Effectiveness was expressed as quality-adjusted life month in the perioperative analyses and quality-adjusted life years in the lifetime analyses. The primary outcome was the incremental cost-effectiveness ratio. RESULTS: In perioperative and lifetime analyses, no screening was least costly and least effective. STOP-Bang + polysomnography was the most effective strategy and was more cost-effective than both STOP-Bang + portable monitor and STOP-Bang alone in both analyses. In perioperative analyses, STOP-Bang + polysomnography was not cost-effective compared to no screening at the $4,167/quality-adjusted life month threshold (incremental cost-effectiveness ratio $52,888/quality-adjusted life month). No screening was favored in more than 90% of iterations in probabilistic sensitivity analyses. In contrast, in lifetime analyses, STOP-Bang + polysomnography was favored compared to no screening at the $50,000/quality-adjusted life year threshold (incremental cost-effectiveness ratio $2,044/quality-adjusted life year). STOP-Bang + polysomnography was favored in most iterations at thresholds above $2,000/quality-adjusted life year in probabilistic sensitivity analyses. CONCLUSIONS: The cost-effectiveness of preoperative obstructive sleep apnea screening differs depending on time horizon. Preoperative screening with STOP-Bang followed by immediate confirmatory testing with polysomnography is cost-effective on the lifetime horizon but not the perioperative horizon. The integration of preoperative screening based on STOP-Bang and polysomnography is a cost-effective means of mitigating the long-term disease burden of obstructive sleep apnea.

Cost-effectiveness of polysomnography in the management of pediatric obstructive sleep apnea.

OBJECTIVES: At our institution, younger children require polysomnography (PSG) testing to confirm obstructive sleep apnea (OSA hereafter) before surgical intervention by adenotonsillectomy (T&A). Given that sleep studies can be costly, we investigated the cost-effectiveness of PSG as well as the possible role for symptom documentation in evaluation for T&A. METHODS: Pediatric patients age 1-3 years who received PSG testing between Jan. 2015 and Jan. 2016 who had not previously had T&A were identified for retrospective cost analysis. Cost data were obtained from institutional accountants. We defined a positive PSG as obstructive apnea-hypopnea index ≥1. Logistic regression analysis was used, and statistical significance was set a priori at p < 0.05. Sensitivities and specificities of symptom documentation screen for OSA were compared to gold standard, or PSG testing. RESULTS: Of the 176 children who received polysomnography testing, 140 (80%) had a positive PSG indicative of OSA. Seventy-one (51%) children with OSA underwent T&A within 1 year of PSG, and 10 (7%) eventually received T&A after 1 year from PSG date. Of the children whose PSG results were negative (n = 36), 14 (39%) still underwent T&A within 1 year (n = 7, 19%) or later (n = 7, 19%). Children with positive sleep studies were significantly more likely to receive T&A within one year of PSG (p = 0.0006) and at any time after PSG (p = 0.04). Hospital costs for T&A varied widely while PSG costs were fairly consistent. Using average institutional costs of T&A and PSG, the total cost of a T&A was 17.7× the cost of PSG testing. Using number of recorded symptoms to diagnose OSA instead of PSG testing yielded low specificities. CONCLUSION: Fifty-eight percent of patients with OSA and 39% of patients without OSA had a T&A within 1 year or later, although positive PSG was significantly associated with a higher likelihood of receiving T&A. Given costs at this institution and current decision-making practices, 147 PSGs would need to be done to account for the cost of one T&A, which in our cohort would occur after approximately 305 days.

A predictive model for obstructive sleep apnea and Down syndrome.

Obstructive sleep apnea (OSA) occurs frequently in people with Down syndrome (DS) with reported prevalences ranging between 55% and 97%, compared to 1-4% in the neurotypical pediatric population. Sleep studies are often uncomfortable, costly, and poorly tolerated by individuals with DS. The objective of this study was to construct a tool to identify individuals with DS unlikely to have moderate or severe sleep OSA and in whom sleep studies might offer little benefit. An observational, prospective cohort study was performed in an outpatient clinic and overnight sleep study center with 130 DS patients, ages 3-24 years. Exclusion criteria included previous adenoid and/or tonsil removal, a sleep study within the past 6 months, or being treated for apnea with continuous positive airway pressure. This study involved a physical examination/medical history, lateral cephalogram, 3D photograph, validated sleep questionnaires, an overnight polysomnogram, and urine samples. The main outcome measure was the apnea-hypopnea index. Using a Logic Learning Machine, the best model had a cross-validated negative predictive value of 73% for mild obstructive sleep apnea and 90% for moderate or severe obstructive sleep apnea; positive predictive values were 55% and 25%, respectively. The model included variables from survey questions, medication history, anthropometric measurements, vital signs, patient's age, and physical examination findings. With simple procedures that can be collected at minimal cost, the proposed model could predict which patients with DS were unlikely to have moderate to severe obstructive sleep apnea and thus may not need a diagnostic sleep study.

Decision Modeling in Sleep Apnea: The Critical Roles of Pretest Probability, Cost of Untreated Obstructive Sleep Apnea, and Time Horizon.

STUDY OBJECTIVES: Obstructive sleep apnea (OSA) is associated with increased morbidity and mortality, and treatment with positive airway pressure (PAP) is cost-effective. However, the optimal diagnostic strategy remains a subject of debate. Prior modeling studies have not consistently supported the widely held assumption that home sleep testing (HST) is cost-effective. METHODS: We modeled four strategies: (1) treat no one; (2) treat everyone empirically; (3) treat those testing positive during in-laboratory polysomnography (PSG) via in-laboratory titration; and (4) treat those testing positive during HST with auto-PAP. The population was assumed to lack independent reasons for in-laboratory PSG (such as insomnia, periodic limb movements in sleep, complex apnea). We considered the third-party payer perspective, via both standard (quality-adjusted) and pure cost methods. RESULTS: The preferred strategy depended on three key factors: pretest probability of OSA, cost of untreated OSA, and time horizon. At low prevalence and low cost of untreated OSA, the treat no one strategy was favored, whereas empiric treatment was favored for high prevalence and high cost of untreated OSA. In-laboratory backup for failures in the at-home strategy increased the preference for the at-home strategy. Without laboratory backup in the at-home arm, the in-laboratory strategy was increasingly preferred at longer time horizons. CONCLUSION: Using a model framework that captures a broad range of clinical possibilities, the optimal diagnostic approach to uncomplicated OSA depends on pretest probability, cost of untreated OSA, and time horizon. Estimating each of these critical factors remains a challenge warranting further investigation.

Cost-effectiveness of obstructive sleep apnea screening for patients with diabetes or chronic kidney disease.

PURPOSE: Obstructive sleep apnea (OSA) is a common disorder with a high prevalence among patients with cardiovascular disease (CVD), diabetes, and chronic kidney disease (CKD). Routine evaluation of OSA for patients with CVD including hypertension has been performed according to the clinical guidelines for both OSA and CVD. However, most patients with diabetes and CKD who could benefit from treatment remain undiagnosed because routine screening of OSA is not recognized as part of standard practice. This study aims to evaluate the cost-effectiveness of OSA screening for patients with diabetes and CKD. METHODS: Cost-effectiveness analysis by a decision tree and Markov modeling from the societal perspective in Japan was carried out to provide evidence based on the economic evaluation of current clinical practice concerning diabetes and CKD. RESULTS: Incremental cost-effectiveness ratios of OSA screening compared with do-nothing were calculated as ¥3,516,976 to 4,514,813/quality-adjusted life year (QALY) (US$35,170 to 45,148/QALY) for diabetes patients and ¥3,666,946 to 4,006,866/QALY (US$36,669 to 40,069/QALY) for CKD patients. CONCLUSIONS: Taking the threshold to judge cost-effectiveness according to a suggested value of social willingness to pay for one QALY gain in Japan as ¥5 million/QALY (US$50,000QALY), OSA screening is cost-effective. Our results suggest that active case screening and treatment of OSA for untreated middle-aged male patients with diabetes or CKD could be justifiable as an efficient use of finite health-care resources in the world with high prevalence of these diseases.

The challenge of undiagnosed sleep apnea in low-risk populations: a decision analysis.

OBJECTIVES: Obstructive sleep apnea (OSA) may contribute to impaired performance among otherwise healthy active duty military personnel. We used decision analysis to evaluate three approaches to identifying and treating OSA in low-risk populations, which may differ from current standard practice for high-risk populations. METHODS: We developed a decision tree to compare two simple strategies for diagnosis and management of sleep apnea in a low-risk population. In one strategy, a simple screening inventory was followed by conventional laboratory polysomnography (split-night), whereas the alternative strategy involved performing home testing in all individuals. This allowed us to weigh the costs associated with large-scale diagnostic approaches against the costs of untreated OSA in a small fraction of the population. RESULTS: We found that the home testing approach was less expensive than the screen-then-test approach across a broad range of other important parameters, including the annual performance cost associated with untreated OSA, the prevalence of OSA, and the duration of active duty. CONCLUSIONS: Assuming even modest annual performance costs associated with untreated OSA, a population strategy involving large-scale home testing is less expensive than a screening inventory approach. These results may inform either targeted or large-scale investigation of undiagnosed OSA in low-risk populations such as active duty military.

Cost-benefit analysis of polysomnography versus Clinical Assessment Score-15 (CAS-15) for treatment of pediatric sleep-disordered breathing.

OBJECTIVE: To determine the cost of medical care using the Clinical Assessment Score-15 (CAS-15) scale versus polysomnography (PSG) for children with sleep-disordered breathing in terms of benefit. STUDY DESIGN: Cost-benefit analysis. SETTING: Hospital-based pediatric otolaryngology practice. SUBJECTS AND METHODS: Ninety-three patients from our original CAS-15 study were included. Four clinical measures were used and payment data were obtained. Cost-benefit analysis was performed for 2 clinical pathways. In pathway 1, all children had PSG; those with positive studies were referred for adenotonsillectomy. In pathway 2, children with CAS-15 ≥ 32 were referred for adenotonsillectomy regardless of PSG. Paired t test compared intrasubject mean total cost (pathway 1 vs pathway 2). Further analyses computed a change score for the clinical measures (follow-up minus baseline); these were divided by estimated treatment cost, producing 4 cost-benefit ratios for each pathway. Paired t tests compared the mean of these ratios between the pathways. RESULTS: Of 65 PSG+ (15 CAS-), 54 underwent surgery; of 28 PSG- (17 CAS-), 7 underwent surgery. Model estimated costs demonstrate a mean cost benefit of $US1172 (SE = $214) for pathway 2 versus pathway 1 (P < .001). CAS-15 is also cost-beneficial versus PSG in 3 of 4 clinical measures (Child Behavior Checklist total problem T score, P = .008, mean OSA-18 survey score, P < .001, apnea hypopnea index, P < .001). CONCLUSIONS: We present evidence that a CAS-15-based treatment decision criterion is superior to PSG in terms of monetary cost and in benefit per unit cost for 3 of 4 clinical measures evaluated.

Impact of positive airway pressure among obstructive sleep apnea patients.

OBJECTIVES: To evaluate the clinical and economic impact of positive airway pressure (PAP) among patients with obstructive sleep apnea (OSA). STUDY DESIGN: Retrospective claims-based analysis of OSA patients diagnosed with polysomnography (PSG) between January 1, 2005, and April 30, 2008. METHODS: Patients were required to have 2 or more claims for OSA diagnosis within 1 year after their first PSG test, and a minimum of 12 months' baseline and 24 months' follow-up continuous health plan enrollment. Patients with pulmonary disease or PAP use before the first PSG test were excluded. Outcomes included all-cause and sleep apnea-related hospitalization and healthcare costs. Multivariable analyses were performed to adjust for baseline characteristics. RESULTS: Of the 15,424 patients identified, 90.7% used PAP and 9.3% did not. The PAP group had lower all-cause (19.0% vs 24.2%, P <.001) and sleep apnea-related (8.0% vs 11.3%, P <.001) hospitalization rates than the non-PAP group during the follow-up period. After adjusting for baseline characteristics, patients in the PAP group were less likely to have an all-cause (odds ratio [OR] 0.70; 95% confidence interval [CI] 0.61-0.80]) or sleep apnea-related (OR 0.69; 95% CI 0.58-0.83) hospitalization than non-PAP patients. PAP users on average incurred 10% lower all-cause costs than non-PAP patients ($705 per member per month vs $786 per member per month, P <.001) in multivariable analysis. CONCLUSIONS: Among OSA patients in real-world practice, PAP users had significantly lower hospitalization risks and all-cause healthcare costs.

Accuracy of the clinical parameters and oximetry to initiate CPAP in patients with suspected obstructive sleep apnea.

OBJECTIVE: The aim of this study was to assess the accuracy of oximetry and the clinical parameters for the prescription of continuous positive airway pressure (CPAP) in patients with suspected obstructive sleep apnea syndrome (OSAS). METHODS: All participants (135) performed oximetry (WristOx 3100™) and polysomnography (PSG) simultaneously in the sleep laboratory. The patients completed the Epworth sleepiness scale, the Berlin questionnaire, and a clinical history. Two blind independent observers decided to prescribe CPAP according to the results of the PSG (gold standard, observer A), oximetry (alternative method, observer B), and the clinical parameters. The accuracy of observer B on the indication of CPAP, using different cutoff points of the adjusted desaturation index (ADI3 and ADI4), was evaluated by the area under the receiver operating characteristics curve (AUC-ROC). The interobserver agreement for the indication of CPAP was assessed using kappa statistics. RESULTS: One hundred nineteen subjects were included (92 men; mean age, 53; median respiratory disturbance index, 22.6; median BMI, 27.5 kg/m(2)). Depending on the criteria used in oximetry, the sensitivity and specificity of observer B to initiate a CPAP trial ranged from 79.8% to 92.5% and of 92% to 96%, respectively. The best performance for the indication of CPAP was noted with the adjusted O(2) desaturation index ≥ 3% (AUC-ROC, 0.923). The inter-rater agreement for the prescription of CPAP was good (kappa, 0.60 to 0.79). CONCLUSION: This simulated study has shown that the use of oximetry plus clinical data has made it possible to indicate CPAP reliably in nearly 90% of the population with OSAS.

Monitorização portátil no diagnóstico da apneia obstrutiva do sono: situação atual, vantagens e limitações / Portable monitoring devices in the diagnosis of obstructive sleep apnea: current status, advantages, and limitations

Nos últimos anos, é crescente o interesse pela utilização de aparelhos de monitoramento portáteis para o diagnóstico da síndrome da apneia obstrutiva do sono, como uma alternativa mais simples e confortável à polissonografia, que é o exame considerado o padrão ouro para o diagnóstico dessa condição relativamente prevalente. A liberação do uso desses equipamentos pelo Center of Medicare and Medicaid Services, agência federal que administra os serviços médicos nos Estados Unidos da América, em 2008, resultou em ampla discussão sobre a utilidade e validade desses equipamentos para o diagnóstico de síndrome da apneia obstrutiva do sono. Apesar de haver vários modelos de equipamentos de monitorização portátil, há pouca informação na literatura a respeito de como cada equipamento deveria ser utilizado em grupos etários específicos, portadores de comorbidades e pacientes assintomáticos. Além disso, estudos de custo-efetividade desse método diagnóstico são escassos e conflitantes. Portanto, o objetivo do presente estudo foi revisar a evolução dos conhecimentos no uso de equipamentos de monitorização portátil, bem como examinar os avanços recentes, vantagens, limitações e aplicações desses equipamentos para o diagnóstico de apneia obstrutiva do sono em diferentes grupos de pacientes.

Recent years have seen a growing interest in the use of portable monitoring devices for the diagnosis of obstructive sleep apnea syndrome. These have the potential to be used in lieu of the more complicated and uncomfortable alternative, polysomnography, which has long been considered to be the gold standard for the diagnosis of this relatively prevalent condition. Following their approval in 2008 by the Center of Medicare and Medicaid Services, the federal agency which administers Medicare and Medicaid in the United States, there has been extensive discussion about the utility and validity of these devices for use in the diagnosis of obstructive sleep apnea syndrome. Although there are various models of portable monitoring devices, the literature contains little information regarding how each device should be used in specific age groups, patients presenting comorbidities, and asymptomatic patients. Additionally, studies about the cost-effectiveness of this diagnostic method are scarce and conflicting. Therefore, this objective of this study was to review what has been learned about portable monitoring devices over time, as well as to examine the recent progress, advantages, limitations, and applications of these devices in the diagnosis of obstructive sleep apnea syndrome in different groups of patients.

Obstructive sleep apnea and stroke.

Obstructive sleep apnea (OSA) and stroke are frequent, multifactorial entities that share risk factors, and for which case-control and cross-sectional studies have shown a strong association. Stroke of respiratory centers can lead to apnea. Snoring preceding stroke, documentation of apneas immediately prior to transient ischemic attacks, the results of autonomic studies, and the circadian pattern of stroke, suggest that untreated OSA can contribute to stroke. Although cohort studies indicate that OSA is a stroke risk factor, controversy surrounds the cost-effectiveness of the screening for and treatment of OSA once stroke has occurred.

Low socioeconomic status is a risk factor for CPAP acceptance among adult OSAS patients requiring treatment.

STUDY OBJECTIVE: To evaluate whether socioeconomic status (SES) has a role in obstructive sleep apnea syndrome (OSAS) patients' decision to accept continuous positive airway pressure (CPAP) treatment. DESIGN: Cross-sectional study; patients were recruited between March 2007 and December 2007. SETTING: University-affiliated sleep laboratory. PATIENTS: 162 consecutive newly diagnosed (polysomnographically) adult OSAS patients who required CPAP underwent attendant titration and a 2-week adaptation period. RESULTS: 40% (n = 65) of patients who required CPAP therapy accepted this treatment. Patients accepting CPAP were older, had higher apnea-hypopnea index (AHI) and higher income level, and were more likely to sleep in a separate room than patients declining CPAP treatment. More patients who accepted treatment also reported receiving positive information about CPAP treatment from family or friends. Multiple logistic regression (after adjusting for age, body mass index, Epworth Sleepiness Scale, and AHI) revealed that CPAP purchase is determined by: each increased income level category (OR, 95% CI) (2.4; 1.2-4.6), age + 1 year (1.07; 1.01-1.1), AHI ( > or = 35 vs. < 35 events/hr) (4.2, 1.4-12.0), family and/or friends with positive experience of CPAP (2.9, 1.1-7.5), and partner sleeps separately (4.3, 1.4-13.3). CONCLUSIONS: In addition to the already known determinants of CPAP acceptance, patients with low SES are less receptive to CPAP treatment than groups with higher SES. CPAP support and patient education programs should be better tailored for low SES people in order to increase patient treatment initiation and adherence.

Significance of a screening device (Apnomonitor 5) for sleep apnea syndrome.

OBJECTIVES: The objective was to evaluate the significance of a portable sleep-monitoring device (Apnomonitor 5, Chest Co., Tokyo, Japan) to diagnose sleep apnea syndrome (SAS). METHODS: The Apnomonitor 5 comprised an oronasal thermistor, a pulse oximeter, chest and abdominal belts to monitor the circumferences of the chest and abdomen, a microphone to monitor tracheal sound, a position detector, and an integrative unit. This screening device was commercially available and it had been used to diagnose SAS in our country. Twenty-two consecutive adults who attended Inazawa City Hospital who were suspected for SAS were prospectively enrolled and they undertook the standard polysomnography (PSG) and Apnomonitor 5 simultaneously. The designated polysomnographers analyzed the records of the PSG and Apnomonitor 5. These sleep and respiratory parameters of the devices were compared, the results of which were double-checked by the designated sleep specialist. RESULTS: The apnea-hypopnea index (AHI), apnea index, total number of apnea, and oxygen desaturation index obtained by the PSG and Apnomonitor 5 correlated significantly, whereas the averaged sleep time, total number of hypopnea, hypopnea index, and nadir oxygen saturation differed between the devices. The sensitivity of the Apnomonitor 5 versus PSG was 95% in the SAS patients with the AHI> or =15. CONCLUSIONS: The Apnomonitor 5 can be a sensitive and useful screening device for SAS especially in patients with the AHI> or =15.

Screening for obstructive sleep apnea in stroke patients: a cost-effectiveness analysis.

BACKGROUND AND PURPOSE: Obstructive sleep apnea (OSA) is common after acute ischemic stroke and predicts poor stroke recovery, but whether screening for OSA and treatment by continuous positive airway pressure (CPAP) improves neurological outcome is unknown. We used a cost-effectiveness model to estimate the magnitude of benefit that would be necessary to make polysomnography (PSG) and OSA treatment cost-effective in stroke patients. METHODS: A decision tree modeled 2 alternative strategies: PSG followed by 3 months of CPAP for those found to have OSA versus no screening. The primary outcome was the utility gained through OSA screening and treatment in relation to 2 common willingness-to-pay thresholds of $50,000 and $100,000 per quality-adjusted life year (QALY). RESULTS: Screening resulted in an incremental cost-effectiveness ratio of $49,421 per QALY. Screening is cost-effective as long as the treatment of stroke patients with OSA by CPAP improves patient utilities by >0.2 for a willingness-to-pay of $50,000 per QALY and 0.1 for a willingness-to-pay of $100,000 per QALY. CONCLUSIONS: A clinical trial assessing the effectiveness of CPAP in improving stroke outcome is warranted from a cost-effectiveness standpoint.

Evaluation of a new device for home cardiorespiratory recording in children.

OBJECTIVE: To evaluate the feasibility of using a new home cardiorespiratory recording device (HCRD) in children. DESIGN: Cross-sectional study. PATIENTS: Consecutive children scheduled for adenotonsillectomy to treat habitual snoring and/or apneas at otorhinolaryngology clinics in 2 academic and 7 general hospitals. INTERVENTION: Single-night unattended home cardiorespiratory recording prior to adenotonsillectomy using the HCRD. MAIN OUTCOME MEASURES: Number of technically acceptable recordings and successful recordings with artifact-free signals (respiration, saturation, and nasal flow) present for sufficient duration to allow scoring of the polysomnogram and to make a diagnosis. RESULTS: Of 53 eligible children, 24 participated in the study. The main reason for nonparticipation was refusal of caregivers (n = 16). Mean (SD) age of participants was 4.2 (1.6) years; median Brouillette obstructive sleep apnea score was 2.54. Technically acceptable recordings were obtained in 18 children (75%). Only 7 recordings (29%) were classified as successful. The poorest signal quality was obtained from the nasal cannula. CONCLUSION: Based on strict scoring criteria in this study, the results of single-night unattended recordings at home with the HCRD fell short of expectations.

Willingness to pay for polysomnography in children with obstructive sleep apnea syndrome: a cost-benefit analysis.

OBJECTIVES: To analyze willingness to pay (WTP) for polysomnography (PSG) among parents of children with obstructive sleep apnea syndrome (OSAS). To analyze the cost-benefit of PSG in a collectively funded healthcare system. SETTING: University-affiliated sleep laboratory. SUBJECTS: Parents of 158 boys and 94 girls, who had a mean age of 6.0 +/- 3.9 years. The telephone survey, using a contingent valuation approach, was conducted with 3 groups of parents: those whose children were scheduled for PSG (n = 83), whose children were had had PSG within the previous 6 months (n = 77), and whose children had had PSG and adenotonsillectomy in the previous 6 months (n = 92). RESULTS: Two hundred and fifty-two parents (92% compliance rate), 75% of whom were mothers, responded to the WTP interview. Multivariate analysis revealed that the independent variables influencing WTP were bid (OR = 0.745, P < .001), age times bid (OR = 0.835, P < .05), and affected health status (OR = 3.5, P < .001). The median WTP value for PSG studies of children with OSAS following adenotonsillectomy was dollars 762 plus the savings of dollars 60 to the health care system-subtracting the cost of the dollars 250 PSG study resulted in a monetary benefit of dollars 572 per diagnosis. CONCLUSIONS: We conclude that PSG diagnosis for children with OSAS is beneficial. Decision makers and sleep specialists can use WTP to prioritize allocation of resources to increase the availability of PSG studies for children.

[Diagnosis of nocturnal respiratory disorders. Review of portable screening systems. Analysis and critique of different polysomnographic signals]. / Diagnostic des troubles respiratoires nocturnes. Revue des systèmes portables de dépistage. Analyse et critique des différents signaux polysomnographiques.

Polysomnography in an attended hospital laboratory setting is the gold standard for the diagnosis of sleep-related breathing disorders. However, this method is expensive and waiting lists are long. Portable recording devices that can be used at home have been recently developed to improve upon the problems of polysomnography. We review the recent portable devices validated by polysomnography and discuss their precise role in the assessment of sleep-related respiratory disorders.