Details

Autor(en) / Beteiligte

• Ayas, N.T
• Fox, J
• Epstein, L
• Ryan, C.F
• Fleetham, J.A

Titel

Initial use of portable monitoring versus polysomnography to confirm obstructive sleep apnea in symptomatic patients: An economic decision model

Ist Teil von

• Sleep medicine, 2010-03, Vol.11 (3), p.320-324

Ort / Verlag

Netherlands: Elsevier B.V

Erscheinungsjahr

2010

Quelle

Elsevier ScienceDirect Journals

Beschreibungen/Notizen

• 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.