[Reliability of home respiratory polygraphy for the diagnosis of sleep apnea-hypopnea syndrome: analysis of costs]. / Fiabilidad de la poligrafía respiratoria domiciliaria para el diagnóstico del síndrome de apneas-hipopneas durante el sueño. Análisis de costes.

OBJECTIVES: To evaluate the reliability of home respiratory polygraphy for the diagnosis of sleep apnea-hypopnea syndrome (SAHS) and to compare the cost of this technique with that of nighttime polysomnography performed in a sleep laboratory. PATIENTS AND METHODS: This was a prospective study of a random sample of patients with clinically suspected SAHS in which the participants who underwent both home respiratory polygraphy and nighttime polysomnography were blinded as to the results of their first test. Costs were calculated based on a theoretical population of 1000 individuals. A t test for paired samples, the Pearson correlation coefficient, and a receiver operator characteristic curve were used for the statistical analysis. RESULTS: The study population was composed of 45 patients with a mean (SD) age of 52.3 (11) years of whom 21 (46.6%) were diagnosed with SAHS, defined by an apnea-hypopnea index greater than 10 in nighttime polysomnography. Comparison of the results obtained in both recordings revealed statistically significant correlations for all comparisons. The optimal cutoff in this population was a respiratory disturbance index of 13.7 or more, for which the area under the receiver operating characteristic curve was 87.5% (95% confidence interval, 74.2%-95.4%). The mean cost of home respiratory polygraphy in a patient with suspected SAHS was euro69, whereas that of polysomnography was euro179. CONCLUSIONS: Home respiratory polygraphy is a reliable technique for the diagnosis of SAHS. Using this technique routinely in patients suspected of SAHS will be more economical than using nighttime polysomnography. Uncertain results must be verified by nighttime polysomnography.

Fiabilidad de la poligrafía respiratoria domiciliaria para el diagnóstico del síndrome de apneas-hipopneas durante el sueño. Análisis de costes / Reliability of home respiratory polygraphy for the diagnosis of sleep apnea ­hypopnea syndrome: analysis of costs

Objetivos: El presente estudio se realizó con los siguientes objetivos: a) valorar la fiabilidad de la poligrafía respiratoria domiciliara (PRD) para el diagnóstico de síndrome de apneas-hipopneas durante el sueño (SAHS), y b) comparar los costes derivados de la realización de PRD con los de la polisomnografía nocturna (PSG) efectuada en el laboratorio de sueño. Pacientes y métodos: Se trata de un estudio prospectivo y ciego. La población de estudio estuvo constituida por una selección aleatoria de pacientes con sospecha clínica de SAHS. A todo paciente incluido en el estudio se le realizaron PRD y PSG sin conocer el resultado de la primera. Para el cálculo de costes se utilizó una población teórica de 1.000 personas. Para el análisis estadístico se emplearon la prueba de la t de Student para muestras emparejadas, el coeficiente de correlación de Pearson y el cálculo de las curvas de eficacia diagnóstica. Resultados: Se estudió a 45 pacientes, con una edad media (± desviación estándar) de 52,3 ± 11 años, de los que se diagnosticó de SAHS (índice de apneas-hipopneas ≥ 10 en la PSG) a 21 (46,6%). Al comparar los valores obtenidos en la PRD y la PSG, las correlaciones fueron significativas para todos los pares relacionados. El punto de corte óptimo en nuestra población fue un índice de acontecimientos respiratorios de 13,7 o mayor, con un área bajo la curva de eficacia diagnóstica del 87,5% (intervalo de confianza del 95%, 74,2-95,4%). La realización de una PRD en un paciente con sospecha de SAHS supone un coste medio de 69 €, mientras que el de una PSG es de 179 €. Conclusiones: La PRD es un método fiable para el diagnóstico de SAHS. Su realización de forma protocolizada supone un ahorro respecto a la realización de PSG a todos los pacientes con sospecha de SAHS. Por último, los resultados dudosos de la PRD requieren la realización de PSG

Objectives: To evaluate the reliability of home respiratory polygraphy for the diagnosis of sleep apnea­hypopnea syndrome (SAHS) and to compare the cost of this technique with that of nighttime polysomnography performed in a sleep laboratory. Patients and methods: This was a prospective study of a random sample of patients with clinically suspected SAHS in which the participants who underwent both home respiratory polygraphy and nighttime polysomnography were blinded as to the results of their first test. Costs were calculated based on a theoretical population of 1000 individuals. A t test for paired samples, the Pearson correlation coefficient, and a receiver operator characteristic curve were used for the statistical analysis. Results: The study population was composed of 45 patients with a mean (SD) age of 52.3 (11) years of whom 21 (46.6%) were diagnosed with SAHS, defined by an apnea­hypopnea index greater than 10 in nighttime polysomnography. Comparison of the results obtained in both recordings revealed statistically significant correlations for all comparisons. The optimal cutoff in this population was a respiratory disturbance index of 13.7 or more, for which the area under the receiver operating characteristic curve was 87.5% (95% confidence interval, 74.2%-95.4%). The mean cost of home respiratory polygraphy in a patient with suspected SAHS was €69, whereas that of polysomnography was €179. Conclusions: Home respiratory polygraphy is a reliable technique for the diagnosis of SAHS. Using this technique routinely in patients suspected of SAHS will be more economical than using nighttime polysomnography. Uncertain results must be verified by nighttime polysomnography

La medicina actual: luces y sombras / Current medicine: lights and shadows

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