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Cited by 44Obstructive Sleep Apnea ResearchSleep and related disordersHealth Systems, Economic Evaluations, Quality of Life

Effectiveness of sequential automatic-manual home respiratory polygraphy scoring

Open access
Masa, Juan F., Corral, Jaime, Pereira, Ricardo, Duran-Cantolla, Joaquin, Cabello, Marta, Hernández-Blasco, Luis, Monasterio, Carmen, Alonso-Fernandez, Alberto +4 more·2013·European Respiratory Journal
DOI 10.1183/09031936.00186811
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Abstract

Automatic home respiratory polygraphy (HRP) scoring functions can potentially confirm the diagnosis of sleep apnoea-hypopnoea syndrome (SAHS) (obviating technician scoring) in a substantial number of patients. The result would have important management and cost implications. The aim of this study was to determine the diagnostic cost-effectiveness of a sequential HRP scoring protocol (automatic and then manual for residual cases) compared with manual HRP scoring, and with in-hospital polysomnography. We included suspected SAHS patients in a multicentre study and assigned them to home and hospital protocols at random. We constructed receiver operating characteristic (ROC) curves for manual and automatic scoring. Diagnostic agreement for several cut-off points was explored and costs for two equally effective alternatives were calculated. Of 366 randomised patients, 348 completed the protocol. Manual scoring produced better ROC curves than automatic scoring. There was no sensitive automatic or subsequent manual HRP apnoea–hypopnoea index (AHI) cut-off point. The specific cut-off points for automatic and subsequent manual HRP scorings (AHI >25 and >20, respectively) had a specificity of 93% for automatic and 94% for manual scorings. The costs of manual protocol were 9% higher than sequential HRP protocol; these were 69% and 64%, respectively, of the cost of the polysomnography. A sequential HRP scoring protocol is a cost-effective alternative to polysomnography, although with limited cost savings compared to HRP manual scoring.

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  • When 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 [93]

    The paper identifies home respiratory polygraphy as type 3 monitoring (Introduction, labelled Abstract in our copy) and reports results at an HRP AHI cutoff of 5 (Table 3). It does not report accuracy ranges of 84–91% or 70–78% for populations with assumed prevalences of 87% and 55%, nor does it derive those ranges from seven studies; its analysis uses a polysomnographic AHI cutoff of 15 (Statistical analysis). (LLM, conf=0.81)

    Experimental — accuracy not yet measured

  • Seven 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 [93]

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Authors
Masa, J. F., Corral, J., Pereira, R., Duran-Cantolla, J., Cabello, M., Hernández-Blasco, L., Monasterio, C., Alonso-Fernandez, A., Chiner, E., Vázquez-Polo, F.-J., Montserrat, J. M., & the Spanish Sleep Group
Affiliations
  • Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (ES)
  • Marqués de Valdecilla University Hospital (ES)
  • Bellvitge University Hospital (ES)
ORCID
Venue
European Respiratory Journal
Publisher
European Respiratory Society (ERS)
Published
2012-08-09
Volume
41
Issue
4
Pages
879-887
ISSN
  • 0903-1936 (ISSN-L)
  • 1399-3003
DOI
10.1183/09031936.00186811
OpenAlex
W2155182802
Cited by
44
References
2
Citations by year
2026: 2 · 2025: 1 · 2024: 2 · 2023: 1 · 2022: 5 · 2021: 3 · 2020: 4 · 2019: 3 · 2018: 6 · 2017: 3 · 2016: 6 · 2015: 2 · 2014: 4 · 2013: 2
FWCI
1.72
Type
journal article
Language
en
Open access
Locations
  • European Respiratory Journal (publishedVersion)
  • PubMed (publishedVersion)
  • Acceda (Universidad de Las Palmas de Gran Canaria) (submittedVersion)
Topics
  • Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
Keywords
sleep apnea-hypopnea syndrome, automatic scoring, manual scoring, apnea-hypopnea index, cost-effectiveness, polysomnography, diagnostic accuracy, cut-off values, home sleep testing
MeSH terms
Adolescent, Adult, Aged, Automation, Cost-Benefit Analysis, Female, Humans, Male, Middle Aged, ROC Curve, Spain, Health Care Costs, Polysomnography, Sleep Apnea, Obstructive, Young Adult

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