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        "resumen" => "<span class="elsevierStyleSectionTitle">Objetive</span><p class="elsevierStyleSimplePara elsevierViewall">To assess the diagnostic validity&#44; degree of patient satisfaction&#44; and economic cost of home sleep monitoring compared to conventional polysomnography&#46;</p> <span class="elsevierStyleSectionTitle">Patients and methods</span><p class="elsevierStyleSimplePara elsevierViewall">Consecutive patients with symptoms indicative of sleep apnea-hypopnea syndrome &#40;SAHS&#41; were included&#46; We analyzed the diagnostic yield of home sleep monitoring using the apnea&#8211;hypopnea index &#40;AHI&#41;&#44; number of desaturations of at least 3&#37;&#44; and the percentage time with arterial oxygen saturation below 90&#37;&#46; The degree of patient satisfaction&#44; measured on a visual analogue scale&#44; and the cost of home monitoring were compared with conventional polysomnography&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">The study included 52 patients &#40;42 men and 10 women&#41; with a mean &#40;SD&#41; age of 51&#46;8 &#40;9&#41; years and a body mass index of 32 &#40;5&#41; kg&#47;<span class="elsevierStyleSup">2</span>&#46; Polysomnography and home monitoring revealed an AHI of 33&#46;6 &#40;20&#41; and 31 &#40;19&#41;&#44; respectively &#40;<span class="elsevierStyleItalic">r</span>&#61;0&#46;971&#59; intraclass correlation coefficient &#61; 0&#46;963&#59; <span class="elsevierStyleItalic">P</span>&#60;&#46;001&#41;&#46; The number of desaturations of at least 3&#37; and the percentage time with arterial oxygen saturation below 90&#37; showed significant correlation and concordance &#40;<span class="elsevierStyleItalic">P</span>&#60;&#46;05&#41;&#46; For an AHI cutoff of 10 recorded with polysomnography&#44; home monitoring had a sensitivity of 89&#37; and a specificity of 80&#37;&#44; with an area under the receiver operator characteristic curve of 0&#46;804&#46; For severe SAHS &#40;AHI&#8805;30&#41;&#44; the sensitivity and specificity of home monitoring was 100&#37; &#40;that is&#44; the area under the receiver operating characteristic curve was 1&#41;&#46; For home monitoring&#44; the cost per diagnostic test was &#8364;101&#46;34 less than that of polysomnography&#44; and the patient satisfaction was significantly greater &#40;<span class="elsevierStyleItalic">P</span>&#60;&#46;0001&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">Home sleep monitoring is a valid and cost-effective diagnostic test&#59; patients with symptoms of SAHS are more satisfied with this technique than conventional polysomnography&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p class="elsevierStyleSimplePara elsevierViewall">Comparar la validez diagn&#243;stica&#44; el grado de satisfacci&#243;n del paciente y el coste econ&#243;mico de la poligraf&#237;a domiciliaria respecto a la polisomnograf&#237;a convencional&#46;</p> <span class="elsevierStyleSectionTitle">Pacientes y m&#233;todos</span><p class="elsevierStyleSimplePara elsevierViewall">Se seleccion&#243; consecutivamente a pacientes con s&#237;ntomas indicativos de s&#237;ndrome de apneas hipopneas durante el sue&#241;o &#40;SAHS&#41;&#46; Analizamos la rentabilidad de la poligraf&#237;a domiciliaria mediante el &#237;ndice apneashipopneas &#40;IAH&#41;&#44; el &#237;ndice de desaturaci&#243;n igual o mayor del 3&#37; y el porcentaje de tiempo con una saturaci&#243;n arterial de ox&#237;geno menor del 90&#37;&#46; Se compararon el grado de satisfacci&#243;n del paciente&#44; evaluada con una escala visual&#44; y el coste de la poligraf&#237;a respecto a la polisomnograf&#237;a&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">Se incluy&#243; en el estudio a 52 pacientes &#40;42 varones y 10 mujeres&#41; con una edad media &#177; desviaci&#243;n est&#225;ndar de 51&#44;8 &#177; 9 a&#241;os e &#237;ndice de masa corporal de 32 &#177; 5 kg&#47;<span class="elsevierStyleSup">2</span>&#46; La polisomnograf&#237;a y la poligraf&#237;a obtuvieron un IAH de 33&#44;6 &#177; 20 y de 31 &#177; 19&#44; respectivamente &#40;r &#61; 0&#44;971&#59; coeficiente de correlaci&#243;n intraclase &#61; 0&#44;963&#59; p &#60; 0&#44;001&#41;&#46; Los valores del &#237;ndice de desaturaci&#243;n igual o mayor del 3&#37; y el porcentaje de tiempo con una saturaci&#243;n arterial de ox&#237;geno menor del 90&#37; mostraron una correlaci&#243;n y concordancia significativas &#40;p &#60; 0&#44;05&#41;&#46; Para un IAH obtenido en la polisomnograf&#237;a de 10&#44; la poligraf&#237;a mostr&#243; una sensibilidad del 89&#37; y una especificidad del 80&#37;&#44; con un &#225;rea bajo la curva de eficacia diagn&#243;stica de 0&#44;804&#59; en el SAHS grave &#40;IAH &#8805; 30&#41; la sensibilidad y especificidad de la poligraf&#237;a fue del 100&#37; &#40;&#225;rea bajo la curva de eficacia diagn&#243;stica &#61; 1&#41;&#46; En la poligraf&#237;a&#44; el coste por prueba diagn&#243;stica fue 101&#44;34 &#8364; menor que en la polisomnograf&#237;a&#44; y el grado de satisfacci&#243;n del paciente&#44; significativamente mayor &#40;p &#60; 0&#44;0001&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">La poligraf&#237;a domiciliaria es una t&#233;cnica diagn&#243;stica v&#225;lida y coste-eficiente&#44; que aporta mayor grado de satisfacci&#243;n que la polisomnograf&#237;a convencional al paciente con s&#237;ntomas de SAHS&#46;</p>"
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                    0 => array:2 [
                      "titulo" => "The association between sleep apnea and the risk of traffic accidents"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J Ter&#225;n-Santos"
                            1 => "A Jim&#233;nez-G&#243;mez"
                            2 => "J Cordero-Guevara"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJM199903183401104"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "1999"
                        "volumen" => "340"
                        "paginaInicial" => "847"
                        "paginaFinal" => "851"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10080847"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib6"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Automobile accident in patients with sleep apnea syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "F Barb&#233;"
                            1 => "J Peric&#225;s"
                            2 => "A Mu&#241;oz"
                            3 => "L Findley"
                            4 => "JM Ant&#243;"
                            5 => "AGN Agust&#237;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/ajrccm.158.1.9709135"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "1998"
                        "volumen" => "158"
                        "paginaInicial" => "18"
                        "paginaFinal" => "22"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9655701"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib7"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Continuous positive airways pressure for obstructive sleep apnoea"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J White"
                            1 => "J Wright"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Cochrane Database Syst Rev"
                        "fecha" => "2002"
                        "numero" => "2"
                        "paginaInicial" => "CD001106"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib8"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Consenso nacional sobre el s&#237;ndrome de apneas-hipopneas del sue&#241;o"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Grupo Espa&#241;ol de Sue&#241;o"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Bronconeumol"
                        "fecha" => "2005"
                        "volumen" => "41"
                        "numero" => "Supl 4"
                        "paginaInicial" => "1"
                        "paginaFinal" => "110"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib9"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Should patients with sleep apnoea&#47;hypopnoea syndrome be diagnosed and managed on the basis of home sleep studies&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "O Parra"
                            1 => "N Garc&#237;a Esclasan"
                            2 => "JM Monserrat"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "1997"
                        "volumen" => "10"
                        "paginaInicial" => "1720"
                        "paginaFinal" => "1724"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9272909"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib10"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Evaluation of home vs laboratory polysomnography in the diagnosis of sleep apnea syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "F Portier"
                            1 => "A Portmann"
                            2 => "P Czernichow"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/ajrccm.162.3.9908002"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2000"
                        "volumen" => "162"
                        "paginaInicial" => "814"
                        "paginaFinal" => "818"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10988088"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib11"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Poligraf&#237;a domiciliaria"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "B Jurado G&#225;mez"
                            1 => "JM Rubio S&#225;nchez"
                            2 => "L Mu&#241;oz Cabrera"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "&#191;Es una t&#233;cnica v&#225;lida para el diagn&#243;stico del s&#237;ndrome de apneas obstructivas del sue&#241;o&#63; Neumosur"
                        "fecha" => "2005"
                        "volumen" => "17"
                        "paginaInicial" => "184"
                        "paginaFinal" => "189"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib12"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "AValidaci&#243;n de la versi&#243;n espa&#241;ola del test de somnolencia Epworth en pacientes con s&#237;ndrome de apnea de sue&#241;o"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "E Chiner"
                            1 => "J Arriero"
                            2 => "J Signes-Costa"
                            3 => "J Marco"
                            4 => "I Fuentes"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Bronconeumol"
                        "fecha" => "1999"
                        "volumen" => "35"
                        "paginaInicial" => "422"
                        "paginaFinal" => "427"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10596338"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib13"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A Rechtschaffen"
                            1 => "A Kales"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:4 [
                        "titulo" => "A manual of standardized terminology&#44; techniques and scoring system for sleep stages of human subjects"
                        "fecha" => "1968"
                        "editorial" => "Government Printing Office"
                        "editorialLocalizacion" => "Washington DC"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib14"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Normativas SEPAR&#58; diagn&#243;stico del s&#237;ndrome de apneas obstructivas durante el sue&#241;o&#58; informe de consenso del &#225;rea de insuficiencia respiratoria y trastornos del sue&#241;o"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "F Barb&#233;"
                            1 => "J Amilibia"
                            2 => "F Capote"
                            3 => "J Dur&#225;n"
                            4 => "NG Mangado"
                            5 => "A Jim&#233;nez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Bronconeumol"
                        "fecha" => "1995"
                        "volumen" => "31"
                        "paginaInicial" => "460"
                        "paginaFinal" => "462"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8520818"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib15"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The occurrence of sleep disorders breathing among middle aged adults"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "T Young"
                            1 => "M Palta"
                            2 => "J Dempsey"
                            3 => "J Skatrud"
                            4 => "S Weber"
                            5 => "S Badr"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJM199304293281704"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "1993"
                        "volumen" => "328"
                        "paginaInicial" => "1230"
                        "paginaFinal" => "1236"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8464434"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib16"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Obstructive sleep apneahypopnea and related clinical features in a population-based sample of subjects aged 30 to 70 yr"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J Dur&#225;n"
                            1 => "S Esnaola"
                            2 => "R Rubio"
                            3 => "A Iztueta"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/ajrccm.163.3.2005065"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2001"
                        "volumen" => "163"
                        "paginaInicial" => "685"
                        "paginaFinal" => "689"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11254524"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib17"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Utilization of health care services in patients with severe obstructive sleep apnea"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "MH Kryger"
                            1 => "L Ross"
                            2 => "K Delaive"
                            3 => "R Walld"
                            4 => "J Horrocks"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Sleep"
                        "fecha" => "1996"
                        "volumen" => "19"
                        "paginaInicial" => "S111"
                        "paginaFinal" => "S1S6"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9122567"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib18"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Health care utilization in the 10 years prior to diagnosis in obstructive sleep apnea patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J Ronald"
                            1 => "K Delaive"
                            2 => "L Roos"
                            3 => "J Manfreda"
                            4 => "A Bahammam"
                            5 => "MH Kryger"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Sleep"
                        "fecha" => "1999"
                        "volumen" => "2"
                        "paginaInicial" => "225"
                        "paginaFinal" => "229"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib19"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "El s&#237;ndrome de apneas-hipopneas durante el sue&#241;o en Espa&#241;a&#46; Disponibilidad de recursos para su diagn&#243;stico y tratamiento en los hospitales del Estado espa&#241;ol"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J Dur&#225;n-Cantoll&#225;"
                            1 => "J Mar"
                            2 => "G de la Torre Mu&#241;ecas"
                            3 => "R Rubio Aramendi"
                            4 => "L Guerra"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Bronconeumol"
                        "fecha" => "2004"
                        "volumen" => "40"
                        "paginaInicial" => "259"
                        "paginaFinal" => "267"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15161592"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib20"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Poligraf&#237;a respiratoria en el diagn&#243;stico del s&#237;ndrome de apneas obstructivas durante el sue&#241;o"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "EM Garc&#237;a D&#237;az"
                            1 => "F Capote Gil"
                            2 => "S Cano G&#243;mez"
                            3 => "A S&#225;nchez Armengol"
                            4 => "C Carmona Bernal"
                            5 => "JG Soto Campos"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Bronconeumol"
                        "fecha" => "1997"
                        "volumen" => "33"
                        "paginaInicial" => "69"
                        "paginaFinal" => "73"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9091116"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib21"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Uso secuencial de la pulsioximetr&#237;a nocturna y la poligraf&#237;a respiratoria &#40;AutoSet&#174;&#41; para el diagn&#243;stico del s&#237;ndrome de apneas-hipopneas durante el sue&#241;o en pacientes con alta sospecha cl&#237;nica"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "MA Mart&#237;nez Garc&#237;a"
                            1 => "JJ Soler Catalu&#241;a"
                            2 => "P Rom&#225;n S&#225;nchez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Bronconeumol"
                        "fecha" => "2003"
                        "volumen" => "39"
                        "paginaInicial" => "74"
                        "paginaFinal" => "80"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12586047"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib22"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Home sleep studies in the assessment of sleep apnea&#47;hypopnea syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "R Golpe"
                            1 => "A Jim&#233;nez"
                            2 => "R Carpizo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2002"
                        "volumen" => "122"
                        "paginaInicial" => "1156"
                        "paginaFinal" => "1161"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12377836"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib23"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Measurement of sleep-related breathing disturbances in epidemiological studies&#46; Assessment of the validity and reproducibility of a portable monitoring device"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "S Redline"
                            1 => "T Tosteson"
                            2 => "MA Boucher"
                            3 => "RP Millman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "1991"
                        "volumen" => "100"
                        "paginaInicial" => "1281"
                        "paginaFinal" => "1286"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1935282"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib24"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "One negative polysomnogram does not exclude obstructive sleep apnea"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "TJ Meyer"
                            1 => "SE Eveloff"
                            2 => "LR Kline"
                            3 => "RP Millman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "1993"
                        "volumen" => "103"
                        "paginaInicial" => "756"
                        "paginaFinal" => "760"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8449064"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib25"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Nightly variability in the index of sleep-disordered breathing in men being evaluated for impotence with consecutive night polysomnograms"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "AD Chediak"
                            1 => "JC Acevedo-Crespo"
                            2 => "DJ Seiden"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Sleep"
                        "fecha" => "1996"
                        "volumen" => "19"
                        "paginaInicial" => "589"
                        "paginaFinal" => "592"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8899939"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib26"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Simultaneous laboratory-based comparison of ResMed Autoset with polysomnography in the diagnosis of sleep apnea&#47;hypopnea syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P Mayer"
                            1 => "JC Meurice"
                            2 => "F Philip-Joet"
                            3 => "A Cornette"
                            4 => "D Rakotonanahary"
                            5 => "N Meslier"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "1998"
                        "volumen" => "12"
                        "paginaInicial" => "770"
                        "paginaFinal" => "775"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9817143"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib27"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Validaci&#243;n de un equipo de poligraf&#237;a respiratoria en el diagn&#243;stico del s&#237;ndrome de apneas durante el sue&#241;o"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A Candela"
                            1 => "L Hern&#225;ndez"
                            2 => "S Asensio"
                            3 => "J S&#225;nchez-Pay&#225;"
                            4 => "J Vila"
                            5 => "N Benito"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Bronconeumol"
                        "fecha" => "2005"
                        "volumen" => "41"
                        "paginaInicial" => "71"
                        "paginaFinal" => "77"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15718000"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib28"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Treatment with continuous positive airway pressure is not effective in patients with sleep apnea but no daytime sleepiness"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "F Barb&#233;"
                            1 => "LR Mayorales"
                            2 => "J Dur&#225;n"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Intern Med"
                        "fecha" => "2001"
                        "volumen" => "134"
                        "paginaInicial" => "1015"
                        "paginaFinal" => "1023"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11388814"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib29"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Antioxidant status in patients with sleep apnoea and impact of continuous positive airway pressure treatment"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A Barcel&#243;"
                            1 => "F Barb&#233;"
                            2 => "M de la Pe&#241;a"
                            3 => "M Vila"
                            4 => "G P&#233;rez"
                            5 => "J Pi&#233;rolas"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1183/09031936.06.00067605"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "2006"
                        "volumen" => "27"
                        "paginaInicial" => "756"
                        "paginaFinal" => "760"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16585082"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib30"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hypoxia-sensitive molecules may modulate the develoment of atherosclerosis in sleep apnoea syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M Hayashi"
                            1 => "K Fujimoto"
                            2 => "K Urushibata"
                            3 => "A Takamizawa"
                            4 => "O Kinoshita"
                            5 => "K Kubo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1440-1843.2006.00780.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Respirology"
                        "fecha" => "2006"
                        "volumen" => "11"
                        "paginaInicial" => "24"
                        "paginaFinal" => "31"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16423198"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib31"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Full polysomnography in the home"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "JM Fry"
                            1 => "MA di Phillipo"
                            2 => "K Curran"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Sleep"
                        "fecha" => "1998"
                        "volumen" => "21"
                        "paginaInicial" => "635"
                        "paginaFinal" => "642"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9779523"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
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Vol. 43. Issue 11.
Pages 605-610 (January 2007)
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Vol. 43. Issue 11.
Pages 605-610 (January 2007)
Original Articles
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Cost–Effectiveness and Degree of Satisfaction With Home Sleep Monitoring in Patients With Symptoms of Sleep Apnea
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3883
Bernabé Jurado Gámeza,
Corresponding author
bjg01co@hotmail.com

Correspondence: Dr. B. Jurado Gámez. Servicio de Neumología. Hospital Universitario Reina Sofía. Avda. Menéndez Pidal, s/n. 14004 Córdoba. España
, Javier Redel Monteroa, Luis Muñoz Cabreraa, Mari Carmen Fernández Marína, Elisa Muñoz Gomárizb, Miguel Ángel Martín Péreza, Andrés Cosano Povedanoa
a Servicio de Neumología, Hospital Universitario Reina Sofía, Córdoba, Spain
b Unidad de Investigación, Hospital Universitario Reina Sofía, Córdoba, Spain
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Objetive

To assess the diagnostic validity, degree of patient satisfaction, and economic cost of home sleep monitoring compared to conventional polysomnography.

Patients and methods

Consecutive patients with symptoms indicative of sleep apnea-hypopnea syndrome (SAHS) were included. We analyzed the diagnostic yield of home sleep monitoring using the apnea–hypopnea index (AHI), number of desaturations of at least 3%, and the percentage time with arterial oxygen saturation below 90%. The degree of patient satisfaction, measured on a visual analogue scale, and the cost of home monitoring were compared with conventional polysomnography.

Results

The study included 52 patients (42 men and 10 women) with a mean (SD) age of 51.8 (9) years and a body mass index of 32 (5) kg/2. Polysomnography and home monitoring revealed an AHI of 33.6 (20) and 31 (19), respectively (r=0.971; intraclass correlation coefficient = 0.963; P<.001). The number of desaturations of at least 3% and the percentage time with arterial oxygen saturation below 90% showed significant correlation and concordance (P<.05). For an AHI cutoff of 10 recorded with polysomnography, home monitoring had a sensitivity of 89% and a specificity of 80%, with an area under the receiver operator characteristic curve of 0.804. For severe SAHS (AHI≥30), the sensitivity and specificity of home monitoring was 100% (that is, the area under the receiver operating characteristic curve was 1). For home monitoring, the cost per diagnostic test was €101.34 less than that of polysomnography, and the patient satisfaction was significantly greater (P<.0001).

Conclusions

Home sleep monitoring is a valid and cost-effective diagnostic test; patients with symptoms of SAHS are more satisfied with this technique than conventional polysomnography.

Key words:
Home sleep monitoring
Polysomnography
Sleep-disordered breathing
Sleep apnea–hypopnea syndrome
Objetivo

Comparar la validez diagnóstica, el grado de satisfacción del paciente y el coste económico de la poligrafía domiciliaria respecto a la polisomnografía convencional.

Pacientes y métodos

Se seleccionó consecutivamente a pacientes con síntomas indicativos de síndrome de apneas hipopneas durante el sueño (SAHS). Analizamos la rentabilidad de la poligrafía domiciliaria mediante el índice apneashipopneas (IAH), el índice de desaturación igual o mayor del 3% y el porcentaje de tiempo con una saturación arterial de oxígeno menor del 90%. Se compararon el grado de satisfacción del paciente, evaluada con una escala visual, y el coste de la poligrafía respecto a la polisomnografía.

Resultados

Se incluyó en el estudio a 52 pacientes (42 varones y 10 mujeres) con una edad media ± desviación estándar de 51,8 ± 9 años e índice de masa corporal de 32 ± 5 kg/2. La polisomnografía y la poligrafía obtuvieron un IAH de 33,6 ± 20 y de 31 ± 19, respectivamente (r = 0,971; coeficiente de correlación intraclase = 0,963; p < 0,001). Los valores del índice de desaturación igual o mayor del 3% y el porcentaje de tiempo con una saturación arterial de oxígeno menor del 90% mostraron una correlación y concordancia significativas (p < 0,05). Para un IAH obtenido en la polisomnografía de 10, la poligrafía mostró una sensibilidad del 89% y una especificidad del 80%, con un área bajo la curva de eficacia diagnóstica de 0,804; en el SAHS grave (IAH ≥ 30) la sensibilidad y especificidad de la poligrafía fue del 100% (área bajo la curva de eficacia diagnóstica = 1). En la poligrafía, el coste por prueba diagnóstica fue 101,34 € menor que en la polisomnografía, y el grado de satisfacción del paciente, significativamente mayor (p < 0,0001).

Conclusiones

La poligrafía domiciliaria es una técnica diagnóstica válida y coste-eficiente, que aporta mayor grado de satisfacción que la polisomnografía convencional al paciente con síntomas de SAHS.

Palabras clave:
Poligrafía domiciliaria
Polisomnografía
Trastornos respiratorios del sueño
Síndrome de apneas-hipopneas durante el sueño
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References
[1]
O Parra, A Arboix, S Bechich, L García-Eroles, JM Monserrat, JA López, et al.
Time course of sleep-related breathing disorderes in first-ever stroke or transient ischemic attack.
Am J Respir Crit Care Med, 161 (2000), pp. 375-380
[2]
JM Marín, SJ Carrizo, F Vicente, A Agustí.
Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study.
Lancet, 365 (2005), pp. 1046-1053
[3]
Y Peker, J Carlson, J Hedner.
Increased incidence of coronary artery disease in sleep apnoea: a long-term follow-up.
Eur Respir J, 28 (2006), pp. 596-602
[4]
CM Baldwin, KA Griffith, FJ Nieto, GT O'Connor, JA Walsleben, S Redline.
The association of sleep-disordered breathing and sleep symptoms with quality of life in the Sleep Heart Health Study.
Sleep, 24 (2001), pp. 96-105
[5]
J Terán-Santos, A Jiménez-Gómez, J Cordero-Guevara, et al.
The association between sleep apnea and the risk of traffic accidents.
N Engl J Med, 340 (1999), pp. 847-851
[6]
F Barbé, J Pericás, A Muñoz, L Findley, JM Antó, AGN Agustí.
Automobile accident in patients with sleep apnea syndrome.
Am J Respir Crit Care Med, 158 (1998), pp. 18-22
[7]
J White, J Wright.
Continuous positive airways pressure for obstructive sleep apnoea.
Cochrane Database Syst Rev, (2002), pp. CD001106
[8]
Grupo Español de Sueño.
Consenso nacional sobre el síndrome de apneas-hipopneas del sueño.
Arch Bronconeumol, 41 (2005), pp. 1-110
[9]
O Parra, N García Esclasan, JM Monserrat, et al.
Should patients with sleep apnoea/hypopnoea syndrome be diagnosed and managed on the basis of home sleep studies?.
Eur Respir J, 10 (1997), pp. 1720-1724
[10]
F Portier, A Portmann, P Czernichow, et al.
Evaluation of home vs laboratory polysomnography in the diagnosis of sleep apnea syndrome.
Am J Respir Crit Care Med, 162 (2000), pp. 814-818
[11]
B Jurado Gámez, JM Rubio Sánchez, L Muñoz Cabrera, et al.
Poligrafía domiciliaria.
¿Es una técnica válida para el diagnóstico del síndrome de apneas obstructivas del sueño? Neumosur, 17 (2005), pp. 184-189
[12]
E Chiner, J Arriero, J Signes-Costa, J Marco, I Fuentes.
AValidación de la versión española del test de somnolencia Epworth en pacientes con síndrome de apnea de sueño.
Arch Bronconeumol, 35 (1999), pp. 422-427
[13]
A Rechtschaffen, A Kales.
A manual of standardized terminology, techniques and scoring system for sleep stages of human subjects, Government Printing Office, (1968),
[14]
F Barbé, J Amilibia, F Capote, J Durán, NG Mangado, A Jiménez, et al.
Normativas SEPAR: diagnóstico del síndrome de apneas obstructivas durante el sueño: informe de consenso del área de insuficiencia respiratoria y trastornos del sueño.
Arch Bronconeumol, 31 (1995), pp. 460-462
[15]
T Young, M Palta, J Dempsey, J Skatrud, S Weber, S Badr.
The occurrence of sleep disorders breathing among middle aged adults.
N Engl J Med, 328 (1993), pp. 1230-1236
[16]
J Durán, S Esnaola, R Rubio, A Iztueta.
Obstructive sleep apneahypopnea and related clinical features in a population-based sample of subjects aged 30 to 70 yr.
Am J Respir Crit Care Med, 163 (2001), pp. 685-689
[17]
MH Kryger, L Ross, K Delaive, R Walld, J Horrocks.
Utilization of health care services in patients with severe obstructive sleep apnea.
Sleep, 19 (1996), pp. S111-S1S6
[18]
J Ronald, K Delaive, L Roos, J Manfreda, A Bahammam, MH Kryger.
Health care utilization in the 10 years prior to diagnosis in obstructive sleep apnea patients.
Sleep, 2 (1999), pp. 225-229
[19]
J Durán-Cantollá, J Mar, G de la Torre Muñecas, R Rubio Aramendi, L Guerra.
El síndrome de apneas-hipopneas durante el sueño en España. Disponibilidad de recursos para su diagnóstico y tratamiento en los hospitales del Estado español.
Arch Bronconeumol, 40 (2004), pp. 259-267
[20]
EM García Díaz, F Capote Gil, S Cano Gómez, A Sánchez Armengol, C Carmona Bernal, JG Soto Campos.
Poligrafía respiratoria en el diagnóstico del síndrome de apneas obstructivas durante el sueño.
Arch Bronconeumol, 33 (1997), pp. 69-73
[21]
MA Martínez García, JJ Soler Cataluña, P Román Sánchez.
Uso secuencial de la pulsioximetría nocturna y la poligrafía respiratoria (AutoSet®) para el diagnóstico del síndrome de apneas-hipopneas durante el sueño en pacientes con alta sospecha clínica.
Arch Bronconeumol, 39 (2003), pp. 74-80
[22]
R Golpe, A Jiménez, R Carpizo.
Home sleep studies in the assessment of sleep apnea/hypopnea syndrome.
Chest, 122 (2002), pp. 1156-1161
[23]
S Redline, T Tosteson, MA Boucher, RP Millman.
Measurement of sleep-related breathing disturbances in epidemiological studies. Assessment of the validity and reproducibility of a portable monitoring device.
Chest, 100 (1991), pp. 1281-1286
[24]
TJ Meyer, SE Eveloff, LR Kline, RP Millman.
One negative polysomnogram does not exclude obstructive sleep apnea.
Chest, 103 (1993), pp. 756-760
[25]
AD Chediak, JC Acevedo-Crespo, DJ Seiden, et al.
Nightly variability in the index of sleep-disordered breathing in men being evaluated for impotence with consecutive night polysomnograms.
Sleep, 19 (1996), pp. 589-592
[26]
P Mayer, JC Meurice, F Philip-Joet, A Cornette, D Rakotonanahary, N Meslier, et al.
Simultaneous laboratory-based comparison of ResMed Autoset with polysomnography in the diagnosis of sleep apnea/hypopnea syndrome.
Eur Respir J, 12 (1998), pp. 770-775
[27]
A Candela, L Hernández, S Asensio, J Sánchez-Payá, J Vila, N Benito, et al.
Validación de un equipo de poligrafía respiratoria en el diagnóstico del síndrome de apneas durante el sueño.
Arch Bronconeumol, 41 (2005), pp. 71-77
[28]
F Barbé, LR Mayorales, J Durán, et al.
Treatment with continuous positive airway pressure is not effective in patients with sleep apnea but no daytime sleepiness.
Ann Intern Med, 134 (2001), pp. 1015-1023
[29]
A Barceló, F Barbé, M de la Peña, M Vila, G Pérez, J Piérolas, et al.
Antioxidant status in patients with sleep apnoea and impact of continuous positive airway pressure treatment.
Eur Respir J, 27 (2006), pp. 756-760
[30]
M Hayashi, K Fujimoto, K Urushibata, A Takamizawa, O Kinoshita, K Kubo.
Hypoxia-sensitive molecules may modulate the develoment of atherosclerosis in sleep apnoea syndrome.
[31]
JM Fry, MA di Phillipo, K Curran, et al.
Full polysomnography in the home.
Sleep, 21 (1998), pp. 635-642

Research project partially funded by the Neumosur Foundation.

Copyright © 2007. Sociedad Española de Neumología y Cirugía Torácica (SEPAR)
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