Is there a cost-effective way to diagnose mild sleep-disordered breathing?

Question of the study: To determine the utility and the cost-effectiveness of oesophageal pressure, respiratory flow and movement, and oximetry (ORO) as a diagnostic tool for mild sleep-disordered breathing (SDB), as compared with overnight polysomnography (PSG). Patients and methods: Seventy-nine p...

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Bibliographic Details
Published in:Respiratory medicine 2002-08, Vol.96 (8), p.586-593
Main Authors: BACHOUR, A., HERRALA, J., MAASILTA, P.
Format: Article
Language:English
Subjects:
Adult
Aged
Biological and medical sciences
Cost-Benefit Analysis
cost-effectiveness
Humans
Medical sciences
Middle Aged
mild sleep-disordered breathing
oesophageal pressure
Oximetry - economics
Pneumology
Polysomnography - economics
Respiratory system : syndromes and miscellaneous diseases
Sensitivity and Specificity
Sleep Apnea Syndromes - diagnosis
Sleep Apnea Syndromes - economics
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Summary:Question of the study: To determine the utility and the cost-effectiveness of oesophageal pressure, respiratory flow and movement, and oximetry (ORO) as a diagnostic tool for mild sleep-disordered breathing (SDB), as compared with overnight polysomnography (PSG). Patients and methods: Seventy-nine patients evaluated for mild SDB by PSG and simultaneously by oesophageal pressure (Pes) measurement, oximetry, respiratory flow and respiratory movement on a single night. An oesophageal event (OE) was defined as irregular respiration with crescendo in Pes and rapid return to baseline with a minimal increase in the negative Pes at the end of the OE of at least 5 cm H2O or more than 50% of the baseline level. SDB was defined by ORO when oesophageal events were >5/h, and by PSG when the respiratory disturbance index was >5/h. The diagnostic accuracy and cost-effectiveness of ORO were compared with PSG. Results: Although the ability of ORO to detect SDB was poor: sensitivity 64%, specificity 78%, use of ORO for screening prior to PSG would have saved 5000 EUR per 100 patients compared to initial PSG. Conclusion: Using the combination of oesophageal pressure, respiratory flow and movement and oximetry for the diagnosis of mild SDB is not cost-effective, because of its poor diagnostic accuracy. New devices having alternative means to predict arousal and respiratory effort variation should be evaluated for cost-effectiveness.
ISSN:0954-6111
1532-3064
DOI:10.1053/rmed.2002.1306