Effectiveness of home respiratory polygraphy for the diagnosis of sleep apnoea and hypopnoea syndrome
Open accessAbstract
INTRODUCTION: Home respiratory polygraphy (HRP) may be a cost-effective alternative to polysomnography for the diagnosis of sleep apnoea-hypopnoea syndrome (SAHS), but stronger evidence is needed. Normally, patients transport HRP equipment from the hospital to home and back, which may create difficulties for some patients. OBJECTIVES: To determine both the diagnostic efficacy and cost of HRP (with and without a transportation service moving the device and telematic transmission of data) in a large sample compared with in-hospital polysomnography. METHODS: Patients suspected of having SAHS were included in a multicentre study (eight hospitals). They were assigned to home and hospital protocols in random order. Receiver operating characteristic curves were constructed for manual respiratory polygraphy scoring protocol and different polysomnographic cut-off points. Diagnostic efficacies for several polysomnographic cut-off points were explored and costs for two equally effective alternatives were calculated. RESULTS: Of 366 randomised patients, 348 completed the protocol. The best receiver operating characteristic curve was obtained with a polysomnographic cut-off of the apnoea-hypopnoea index (AHI)≥5. The sensitive HRP AHI cut-off point (<5) had a sensitivity of 96%, a specificity of 57% and a negative likelihood ratio (LR) of 0.07; the specific cut-off (>10) had a sensitivity of 87%, a specificity of 86% and a positive LR of 6.25. The cost of HRP was half that of polysomnography. Telematic transmission costs were similar if the patients' costs were taken in to account. CONCLUSION: HRP is an alternative to polysomnography in patients with suspected SAHS. Telematic procedures may help patients with limited mobility and those who live a long way from the sleep centre.
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There is increasing evidence supporting use of some home-based type III and IV sleep studies to rule-in but not rule-out moderate to severe OSA.
“There is increasing evidence supporting the use of some home-based type III and IV type sleep studies to “rule-in” but not “rule-out”580 moderate to severe OSA.”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [580]
The Discussion (page not available) states that home respiratory polygraphy can both exclude and confirm sleep apnoea–hypopnoea syndrome. The Diagnostic efficacy section likewise reports cut-offs that effectively excluded it, including at a polysomnographic AHI threshold of 15. Although the Introduction describes a recommendation to follow a negative home test with polysomnography, the paper’s own findings contradict the claim that these studies can rule in but not rule out disease; it studies type III monitoring, not type IV. (LLM, conf=0.88)
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Experimental — accuracy not yet measuredWhen using an AHI ≥ 5 cutoff, accuracy of Type 3 HSAT devices in a high-risk population (assuming a prevalence of 87%) ranged from 84% to 91%, whereas in a low-risk population (assuming a prevalence of 55%) accuracy ranged from 70% to 78%.
“When using an AHI ≥ 5 cutoff, accuracy in a high-risk population (assuming a prevalence of 87%) ranged from 84% to 91%, whereas in a low-risk population (assuming a prevalence of 55%) accuracy ranged from 70% to 78% based on the seven studies”
From Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline (2017) · cites this paper as [88]
The Diagnostic efficacy of HRP section reports high diagnostic accuracy at a polysomnographic AHI cutoff of ≥5, so the paper supports the general point about home respiratory polygraphy. It reports a 90% pretest prevalence for that cutoff, however, and neither that section nor Table 2 gives the claimed 87% and 55% prevalence scenarios or their 84–91% and 70–78% accuracy ranges. The Discussion describes this paper as a single multicentre study, not an analysis of seven studies. (LLM, conf=0.84)
Experimental — accuracy not yet measuredSeven studies evaluated the performance of Type 3 HSAT devices against PSG, with AHI cutoffs varying across studies.
“Seven studies evaluated the performance of Type 3 HSAT devices against PSG, but the AHI cutoffs employed varied across studies, resulting in sub-grouping by AHI cutoffs for our analyses.”
From Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline (2017) · cites this paper as [88]
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- Authors
- Masa, J. F., Corral, J., Pereira, R., Duran-Cantolla, J., Cabello, M., Hernandez-Blasco, L., Monasterio, C., Alonso, A., Chiner, E., Rubio, M., Garcia-Ledesma, E., Cacelo, L., Carpizo, R., Sacristan, L., Salord, N., Carrera, M., Sancho-Chust, J. N., Embid, C., Vazquez-Polo, F.-J., Negrin, M. A., & Montserrat, J. M.
- Affiliations
- Hospital San Pedro de Alcántara (ES)
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (ES)
- Marqués de Valdecilla University Hospital (ES)
- Bellvitge University Hospital (ES)
- Hospital Universitari Sant Joan D'Alacant (ES)
- Hospital Txagorritxu (ES)
- Hospital Universitario Son Dureta (ES)
- Hospital Clínic de Barcelona (ES)
- Corresponding author
- Masa, J. F.
- ORCID
- Venue
- Thorax
- Publisher
- BMJ
- Published
- 2011-05-20
- Volume
- 66
- Issue
- 7
- Pages
- 567-573
- ISSN
- 0040-6376 (ISSN-L)
- OpenAlex
- W2127808446
- Semantic Scholar
- a9a0fbea5374d5120655df662e130d8afdb0ccbf
- Cited by
- 161
- References
- 49
- Citations by year
- 2026: 5 · 2025: 5 · 2024: 6 · 2023: 14 · 2022: 11 · 2021: 13 · 2020: 7 · 2019: 10 · 2018: 11 · 2017: 18 · 2016: 12 · 2015: 13 · 2014: 11 · 2013: 15 · 2012: 8
- FWCI
- 7.85
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Thorax (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- Ministerio de Ciencia e Innovación
- Sociedad Española de Neumología y Cirugía Torácica
- Instituto de Salud Carlos III
- Topics
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Neuroscience of respiration and sleep
- Keywords
- sleep apnea-hypopnea syndrome, polysomnography, diagnostic accuracy, apnea-hypopnea index, cost-effectiveness, telemetric data transmission, diagnostic thresholds
- MeSH terms
- Adolescent, Adult, Aged, Cost-Benefit Analysis, Epidemiologic Methods, Female, Humans, Male, Middle Aged, Sleep Apnea Syndromes, Telemetry, Transportation, Health Care Costs, Polysomnography, Home Care Services, Hospital-Based, Young Adult
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