Initial use of portable monitoring versus polysomnography to confirm obstructive sleep apnea in symptomatic patients: an economic decision model.
Sleep Med
; 11(3): 320-4, 2010 Mar.
Article
en En
| MEDLINE
| ID: mdl-20133189
ABSTRACT
BACKGROUND:
When using portable (level III and level IV) studies to "rule in" obstructive sleep apnea (OSA) in symptomatic patients, the pre-test probability (P) needs to be sufficiently high to minimize patients with negative tests who require full polysomnography.METHODS:
We used a theoretical decision analysis model to assess the pre-test probability above which it would be appropriate to use portable studies to rule in disease in symptomatic patients with suspected OSA. For the base case, we considered a symptomatically sleepy patient referred with a probability of OSA of P. We determined the lower threshold of P appropriate for a clinical algorithm based upon an initial ambulatory study compared to initial diagnosis with PSG by comparing costs using the PSG algorithm with a diagnostic algorithm involving initial assessment with a portable study.RESULTS:
In our base case, the pre-test probability above which portable testing would be less costly than initial diagnostic PSG would be 0.47. When an initial split night study was compared to portable testing, the pre-test probability above which portable testing was more economically attractive was greater (0.68). Values of P, however, varied considerably depending on values of many variables, including costs of diagnostic testing and CPAP compliance.CONCLUSIONS:
Using a decision model, we have developed a theoretical framework to ascertain the pre-test disease probability above which portable studies would be economically attractive as an initial test in the assessment of patients with suspected OSA.
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Polisomnografía
/
Apnea Obstructiva del Sueño
/
Monitoreo Fisiológico
Tipo de estudio:
Diagnostic_studies
/
Health_economic_evaluation
/
Prognostic_studies
Límite:
Humans
Idioma:
En
Revista:
Sleep Med
Asunto de la revista:
NEUROLOGIA
/
PSICOFISIOLOGIA
Año:
2010
Tipo del documento:
Article
País de afiliación:
Canadá