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document
Home sleep studies in the assessment of sleep apnea/hypopnea syndrome . OBJECTIVE To determine the clinical utility of a limited sleep-recording device used unsupervised in the patient 's home , compared with in-laboratory , fully supervised polysomnography for the diagnosis of sleep apnea/hypopnea syndrome ( SAHS ) , and to assess its impact on costs . DESIGN Prospective case study . SETTING The sleep-disorders unit of a tertiary referral university hospital . PATIENTS Fifty-five patients suspected of having SAHS and living within 30 km of our laboratory . METHODS Patients were studied first in their homes with the limited sleep-recording device . Polysomnography was performed within 30 days of the first study . Both studies were read by independent investigators blinded to the results of the other study . Diagnoses and therapeutic decisions regarding the use of continuous positive airway pressure obtained from the home and laboratory studies were compared . Agreement between the home and laboratory study recordings was also assessed using receiver operating characteristic ( ROC ) curves and Bland-Altman analysis . One half of the home studies were randomly assigned to be performed with a sleep technician 's set up of the equipment in the patient 's home ( group 1 ) , and the other half with the patient 's own setup of the sleep-recording device ( group 2 ) , after an instruction period in the hospital . An economic analysis was performed , considering the cost of repeating studies in cases with faulty or inconclusive home studies ( these patients should undergo polysomnography as a second step ) . RESULTS Seven percent of the home studies in group 1 , and 33 % in group 2 produced no interpretable data because of artifacts ( p < 0.05 ) . Sixteen percent of the home study findings were inconclusive . The diagnosis obtained from the limited sleep-recording device and polysomnography agreed in 75 % of the interpretable home studies ( 89 % , if inconclusive home studies were excluded ) . The area under the ROC curve for the home study-derived parameters was between 0.84 and 0.89 , compared with polysomnography . There was no bias between home and polysomnography studies in the Bland-Altman plot . The cost per study of home study recordings was less expensive than that of polysomnography ( 143.86 euros ) , either with ( 93.08 euros ) or without ( 129.97 euros ) intervention of the technician in the patient 's home . CONCLUSION Home sleep studies are a viable form of diagnosing SAHS , and are less expensive than polysomnography . Intervention of a sleep technician in the patient 's home was the least expensive strategy , because of the high percentages of faulty studies with the patient 's own setup of the equipment , when using the limited sleep-recording device .
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Intervention_Educational
Home sleep studies
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Intervention_Educational
limited sleep-recording device .
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Intervention_Physical
Polysomnography
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Intervention_Physical
polysomnography
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Intervention_Physical
Home sleep
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Outcome_Physical
sleep apnea/hypopnea syndrome
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Outcome_Physical
sleep apnea/hypopnea syndrome ( SAHS )
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Outcome_Other
costs
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Outcome_Physical
area under the ROC curve
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Outcome_Other
cost per study of home study recordings
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Outcome_Other
expensive
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Outcome_Other
expensive
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Participant_Condition
sleep apnea/hypopnea syndrome .
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Participant_Condition
sleep apnea/hypopnea syndrome ( SAHS )
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Participant_Sample-size
Fifty-five patients