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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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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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Research project partially funded by the Neumosur Foundation.

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