Should patients with sleep apnoea/hypopnoea syndrome be diagnosed and managed on the basis of home sleep studies?

The purpose of this study was to analyse the validity and the economic efficiency of a portable monitor of respiratory parameters (PMRP), used in a home setting for the diagnosis of sleep apnoea/hypopnoea syndrome (SAHS). Eighty nine patients with suspected SAHS were studied in two settings: in the sleep laboratory using full-polysomnography (full-PSG); and at the patient's home using a PMRP. In the home setting, 50 patients were assisted by a technician and 39 set up the equipment themselves. SAHS (apnoea/hypopnoea index (AHI) >10 events x h(-1) by means of full-PSG) was diagnosed in 75 of the 89 patients. An acceptable agreement was obtained between the AHI measured by full-PSG and PMRP, according to the Bland and Altman method of concordance (mean bias 2.56; 95% confidence interval 3.25). Sensitivity and specificity of PMRP were adequate for diagnostic purposes; however, their values rely on the prior PMRP-AHI cut-off point selected with reference to full-PSG-AHI >10. The clinical therapeutic decision taken after PMRP agreed with that taken with full-PSG in 79 patients (89%). Although 10% of the studies with an individual set-up needed repetition, both of the domiciliary modalities (with and without a technician's intervention) were, economically, about three times more efficient than full-PSG. In conclusion, we believe that patients with a suspected sleep apnoea/hypopnoea syndrome should initially be studied in a home setting with a portable monitor of respiratory parameters, since it is a reliable method with an acceptable cost-effective profile.

This article has been cited by other articles:

				H. Nakano, T. Tanigawa, Y. Ohnishi, H. Uemori, K. Senzaki, T. Furukawa, and S. Nishima Validation of a single-channel airflow monitor for screening of sleep-disordered breathing Eur. Respir. J., October 1, 2008; 32(4): 1060 - 1067. [Abstract] [Full Text] [PDF]

				L. Hernandez, M. Torrella, N. Roger, A. Llunell, E. Ballester, L. Quinto, M. Serrano, F. Masa, and J. M. Montserrat Management of Sleep Apnea: Concordance Between Nonreference and Reference Centers Chest, December 1, 2007; 132(6): 1853 - 1857. [Abstract] [Full Text] [PDF]

				M. Ahmed, N. P. Patel, and I. Rosen Portable Monitors in the Diagnosis of Obstructive Sleep Apnea Chest, November 1, 2007; 132(5): 1672 - 1677. [Abstract] [Full Text] [PDF]

				E. Garcia-Diaz, E. Quintana-Gallego, A. Ruiz, C. Carmona-Bernal, A. Sanchez-Armengol, G. Botebol-Benhamou, and F. Capote Respiratory Polygraphy With Actigraphy in the Diagnosis of Sleep Apnea-Hypopnea Syndrome Chest, March 1, 2007; 131(3): 725 - 732. [Abstract] [Full Text] [PDF]

				E. Quintana-Gallego, M. Villa-Gil, C. Carmona-Bernal, G. Botebol-Benhamou, A. Martinez-Martinez, A. Sanchez-Armengol, J. Polo-Padillo, and F. Capote Home respiratory polygraphy for diagnosis of sleep-disordered breathing in heart failure Eur. Respir. J., September 1, 2004; 24(3): 443 - 448. [Abstract] [Full Text] [PDF]

				O. Parra, A. Arboix, J.M. Montserrat, L. Quinto, S. Bechich, and L. Garcia-Eroles Sleep-related breathing disorders: impact on mortality of cerebrovascular disease Eur. Respir. J., August 1, 2004; 24(2): 267 - 272. [Abstract] [Full Text] [PDF]

				A. Szucs, J. Janszky, Z. Nagy, G. Migleczi, C. Roffe, S. Sills, M. Halim, K. Wilde, P.W. Jones, M.B. Allen, et al. Is Sleep-Hypoxia Really Unexpected in Acute Stroke? * Nocturnal Hypoxia After Stroke Stroke, June 1, 2004; 35(6): e138 - e139. [Full Text] [PDF]

				W. W. Flemons, M. R. Littner, J. A. Rowley, P. Gay, W. M. Anderson, D. W. Hudgel, R. D. McEvoy, and D. I. Loube Home Diagnosis of Sleep Apnea: A Systematic Review of the Literature: An Evidence Review Cosponsored by the American Academy of Sleep Medicine, the American College of Chest Physicians, and the American Thoracic Society Chest, October 1, 2003; 124(4): 1543 - 1579. [Full Text] [PDF]

				R. Golpe, A. Jimenez, and R. Carpizo Home Sleep Studies in the Assessment of Sleep Apnea/Hypopnea Syndrome Chest, October 1, 2002; 122(4): 1156 - 1161. [Abstract] [Full Text] [PDF]

				T Kohnlein, T Welte, L B Tan, and M W Elliott Central sleep apnoea syndrome in patients with chronic heart disease: a critical review of the current literature Thorax, June 1, 2002; 57(6): 547 - 554. [Abstract] [Full Text] [PDF]

				F. Gagnadoux, N. Pelletier-Fleury, C. Philippe, D. Rakotonanahary, and B. Fleury Home Unattended vs Hospital Telemonitored Polysomnography in Suspected Obstructive Sleep Apnea Syndrome : A Randomized Crossover Trial Chest, March 1, 2002; 121(3): 753 - 758. [Abstract] [Full Text] [PDF]

				P. Lloberes, G. Sampol, G. Levy, D. Aristizabal, T. Sagales, M. De la Calzada, A. Roca, I. Canas, and F. Morell Influence of setting on unattended respiratory monitoring in the sleep apnoea/hypopnoea syndrome Eur. Respir. J., September 1, 2001; 18(3): 530 - 534. [Abstract] [Full Text] [PDF]

				P. Kowallik, I. Jacobi, A. Jirmann, M. Meesmann, M. Schmidt, and H. Wirtz Breath-to-Breath Variability Correlates With Apnea-Hypopnea Index in Obstructive Sleep Apnea Chest, February 1, 2001; 119(2): 451 - 459. [Abstract] [Full Text] [PDF]

				M.-P. d'Ortho, V. Grillier-Lanoir, P. Levy, F. Goldenberg, E. Corriger, A. Harf, and F. Lofaso Constant vs Automatic Continuous Positive Airway Pressure Therapy : Home Evaluation Chest, October 1, 2000; 118(4): 1010 - 1017. [Abstract] [Full Text] [PDF]

				F. PORTIER, A. PORTMANN, P. CZERNICHOW, L. VASCAUT, E. DEVIN, D. BENHAMOU, A. CUVELIER, and J. F. MUIR Evaluation of Home versus Laboratory Polysomnography in the Diagnosis of Sleep Apnea Syndrome Am. J. Respir. Crit. Care Med., September 1, 2000; 162(3): 814 - 818. [Abstract] [Full Text]

				O. PARRA, A. ARBOIX, S. BECHICH, L. GARCÍA-EROLES, J. M. MONTSERRAT, J. A. LÓPEZ, E. BALLESTER, J. M. GUERRA, and J. J. SOPEÑA Time Course of Sleep-related Breathing Disorders in First-Ever Stroke or Transient Ischemic Attack Am. J. Respir. Crit. Care Med., February 1, 2000; 161(2): 375 - 380. [Abstract] [Full Text]