The DOI matches its Crossref record; 67 of the 68 references it cites were found in a registry or an index, and 1 are not checked yet.
An Integrated Health-Economic Analysis of Diagnostic and Therapeutic Strategies in the Treatment of Moderate-to-Severe Obstructive Sleep Apnea
Open accessAbstract
STUDY OBJECTIVES: Obstructive sleep apnea (OSA) is a common disorder associated with substantially increased cardiovascular risks, reduced quality of life, and increased risk of motor vehicle collisions due to daytime sleepiness. This study evaluates the cost-effectiveness of three commonly used diagnostic strategies (full-night polysomnography, split-night polysomnography, unattended portable home-monitoring) in conjunction with continuous positive airway pressure (CPAP) therapy in patients with moderate-to-severe OSA. DESIGN: A Markov model was created to compare costs and effectiveness of different diagnostic and therapeutic strategies over a 10-year interval and the expected lifetime of the patient. The primary measure of cost-effectiveness was incremental cost per quality-adjusted life year (QALY) gained. PATIENTS OR PARTICIPANTS: Baseline computations were performed for a hypothetical average cohort of 50-year-old males with a 50% pretest probability of having moderate-to-severe OSA (apnea-hypopnea index [AHI] ≥ 15 events per hour). MEASUREMENTS AND RESULTS: For a patient with moderate-to-severe OSA, CPAP therapy has an incremental cost-effectiveness ratio (ICER) of $15,915 per QALY gained for the lifetime horizon. Over the lifetime horizon in a population with 50% prevalence of OSA, full-night polysomnography in conjunction with CPAP therapy is the most economically efficient strategy at any willingness-to-pay greater than $17,131 per-QALY gained because it dominates all other strategies in comparative analysis. CONCLUSIONS: Full-night polysomnography (PSG) is cost-effective and is the preferred diagnostic strategy for adults suspected to have moderate-to-severe OSA when all diagnostic options are available. Split-night PSG and unattended home monitoring can be considered cost-effective alternatives when full-night PSG is not available.
Overview
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“The first study 167 demonstrated an incremental cost-effectiveness ratio (ICER) of CDN$15,915 per quality-adjusted life year (QALY) with CPAP therapy”
From Treatment of Adult Obstructive Sleep Apnea With Positive Airway Pressure: An American Academy of Sleep Medicine Systematic Review, Meta-Analysis, and GRADE Assessment (2019) · cites this paper as [167]
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Citations
Cites
Marin, J. M., Carrizo, S. J., Vicente, E., & Agusti, A. G. (2005) · The Lancet · doi:10.1016/s0140-6736(05)71141-7 · Cited by 4,678
Obstructive Sleep Apnea as a Risk Factor for Stroke and Death
Yaggi, H. K., Concato, J., Kernan, W. N., Lichtman, J. H., Brass, L. M., & Mohsenin, V. (2005) · New England Journal of Medicine · doi:10.1056/nejmoa043104 · Cited by 3,004
Lee, J. A. H. (1986) · JAMA · doi:10.1001/jama.1986.03370120114036 · Cited by 2,252
Becker, H. F., Jerrentrup, A., Ploch, T., Grote, L., Penzel, T., Sullivan, C. E., & Peter, J. H. (2003) · Circulation · doi:10.1161/01.cir.0000042706.47107.7a · Cited by 931
Cutler, J. A., Sorlie, P. D., Wolz, M., Thom, T., Fields, L. E., & Roccella, E. J. (2008) · Hypertension · doi:10.1161/hypertensionaha.108.113357 · Cited by 918
Sleep Apnea as an Independent Risk Factor for All-Cause Mortality: The Busselton Health Study
(2008) · Sleep · doi:10.5665/sleep/31.8.1079 · Cited by 889
Long-term Use of CPAP Therapy for Sleep Apnea/Hypopnea Syndrome
McARDLE, N., DEVEREUX, G., HEIDARNEJAD, H., ENGLEMAN, H. M., MACKAY, T. W., & DOUGLAS, N. J. (1999) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/ajrccm.159.4.9807111 · Cited by 820
Lifetime Cost of Stroke in the United States
Taylor, T. N., Davis, P. H., Torner, J. C., Holmes, J. S., Meyer, J. W., & Jacobson, M. F. (1996) · Stroke · doi:10.1161/01.str.27.9.1459 · Cited by 806
Preference-Based EQ-5D Index Scores for Chronic Conditions in the United States
Sullivan, P. W., & Ghushchyan, V. H. (2006) · Medical Decision Making · doi:10.1177/0272989x06290495 · Cited by 707
Access to Diagnosis and Treatment of Patients with Suspected Sleep Apnea
Flemons, W. W., Douglas, N. J., Kuna, S. T., Rodenstein, D. O., & Wheatley, J. R. (2004) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.200308-1124pp · Cited by 678
Flagged first, then by citations
Research works printed but not linked: 2
- [11]Gold MR, Siegel JE, Russell LB, Weinstein MC. Cost-effectiveness in Health and Medicine. New York: Oxford University Press; 1996. [Google Scholar]
- [16]British Heart Foundation Statistics Website. HeartStats. British Heart Foundation; 2009. [Google Scholar]
Cited by
Sorted by citations
Items 101–149 of 149
Value within otolaryngology: Assessment of the cost‐utility analysis literature
Patel, K. R., Phillips, D. J., Leibowitz, J. M., Scognamiglio, T., Banuchi, V., Kuhel, W. I., Kutler, D. I., & Cohen, M. A. (2016) · World Journal of Otorhinolaryngology - Head and Neck Surgery · doi:10.1016/j.wjorl.2016.01.001 · Cited by 5
How to Evaluate a Diagnostic Sleep Study Report
Shangold, L. (2016) · Otolaryngologic Clinics of North America · doi:10.1016/j.otc.2016.07.003 · Cited by 5
Noda, A., Yasuma, F., Miyata, S., Iwamoto, K., Yasuda, Y., & Ozaki, N. (2019) · Health · doi:10.4236/health.2019.112015 · Cited by 5
Versorgung von Schlafapnoe-Patienten in Hessen
Mayer, G., Apelt, S., Heßmann, P., Reese, J., Dodel, R. C., & HEITMANN, J. (2015) · Somnologie - Schlafforschung und Schlafmedizin · doi:10.1007/s11818-015-0021-9 · Cited by 5
Sleep scoring: man vs. machine?
Berthomier, C., & Brandewinder, M. (2012) · Sleep And Breathing · doi:10.1007/s11325-012-0715-1 · Cited by 5
Sim, M. J. H., Poh, Y., Wong, H. S., & Mok, Y. (2025) · Sleep And Breathing · doi:10.1007/s11325-025-03445-6 · Cited by 4
Kaambwa, B., Woods, T.-J., Natsky, A. N., Bulamu, N. B., Mpundu‐Kaambwa, C., Loffler, K. A., Sweetman, A., CATCHESIDE, P. G., Reynolds, A. C., Adams, R., et al. (2024) · PharmacoEconomics · doi:10.1007/s40273-023-01349-5 · Cited by 4
Sleep Deprivation and Economic Burden
Skaer, T. L. (2013) · Springer eBooks · doi:10.1007/978-1-4614-9087-6_19 · Cited by 4
A quantitative representation of continuous brain state during sleep
Kim, H. J., Chen, S., Eden, U. T., & Prerau, M. J. (2021) · International IEEE/EMBS Conference on Neural Engineering · doi:10.1109/ner49283.2021.9441276 · Cited by 4
Suri, J. C., & Suri, T. M. (2023) · Indian Journal of Sleep Medicine · doi:10.5005/jp-journals-10069-0106 · Cited by 4
Champ‐Rigot, L., Ferchaud, V., Prévost, J.-N., Moirot, P., Pellissier, A., Legallois, D., Alexandre, J., Scanu, P., Morello, R., Saloux, É., et al. (2018) · Clinical Medicine Insights Cardiology · doi:10.1177/1179546817751628 · Cited by 3
Portable Monitoring for Diagnosis of Sleep Apnea
Woodson, B. T., & Ishman, S. L. (2013) · Current Otorhinolaryngology Reports · doi:10.1007/s40136-013-0008-7 · Cited by 3
Economic and social costs of sleep apnea
Ehsan, Z., & Ingram, D. (2016) · Current Pulmonology Reports · doi:10.1007/s13665-016-0142-z · Cited by 4
The Effects of an Oral Appliance in Obstructive Sleep Apnea Patients with Prehypertension
Bhushan, A., Tripathi, A., Gupta, A., & Tripathi, S. (2015) · Journal of Dental Sleep Medicine · doi:10.15331/jdsm.4630 · Cited by 3
NIV for OHS without severe OSAS: is it worth it?
Murphy, P. B., & Janssens, J.-P. (2016) · Thorax · doi:10.1136/thoraxjnl-2016-208986 · Cited by 3
Socio-economics perspectives of healthcare in sleep apnea
Krieger, A. C. (2017) · Sleep Medicine · doi:10.1016/j.sleep.2017.09.006 · Cited by 2
Automated Respiratory Event Detection Using Deep Neural NetworksPreprint
Nassi, T. E., Ganglberger, W., Sun, H., Bucklin, A. A., Biswal, S., van Putten, M. J. A. M., THOMAS, R. J., & Westover, M. B. (2021) · arXiv (Cornell University) · doi:10.48550/arxiv.2101.04635 · Cited by 3
Pachori, D., Raj, K., & Jain, T. K. (2025) · doi:10.1109/icsc64553.2025.10968244 · Cited by 2
Los trastornos respiratorios durante el sueño 2018: una nueva dimensión
Montserrat, J. M., Sánchez‐de‐la‐Torre, M., Terán, J., & Egea, C. (2018) · Archivos de Bronconeumología · doi:10.1016/j.arbres.2018.05.012 · Cited by 2
Garner, S. L., & Traverse, R. D. (2013) · Journal of Community Health Nursing · doi:10.1080/07370016.2013.806697 · Cited by 2
Ingram, D. G., Lee-Chiong, T. L., & Londoño, D. (2017) · Revista de la Facultad de Medicina · doi:10.15446/revfacmed.v65n1sup.59570 · Cited by 3
Sleep-Disordered Breathing: Diagnosis
Álvarez, D., Crespo, A., Gozal, D., Gozal, D., & del Campo, F. (2023) · Springer eBooks · doi:10.1007/978-3-031-30010-3_5 · Cited by 1
Predicting Adverse Childhood Experiences via Machine Learning Ensembles
Rao, A. K., Trivedi, G. Y., Bajpai, A., Chauhan, G. S., Trivedi, R. G., Kumar, A., Dutt, V., Kathirvel, S., & Ramani, H. (2023) · International Conference on PErvasive Technologies Related to Assistive Environments (PETRA) · doi:10.1145/3594806.3596591 · Cited by 1
Kim, S. H., & Collop, N. A. (2013) · Sleep Medicine Clinics · doi:10.1016/j.jsmc.2013.07.008 · Cited by 1
The feasibility of a mandibular movement test as a screening tool for polysomnography candidates
Rotty, M.-C., Mallet, J., Borel, J., Suehs, C., BOURDIN, A. A., Molinari, N., & Jaffuel, D. (2017) · European Respiratory Journal · doi:10.1183/13993003.01076-2017 · Cited by 1
Respiratory Disorders During Sleep: A New Dimension for 2018
Montserrat, J. M., Sánchez‐de‐la‐Torre, M., Terán, J., & Egea, C. (2019) · Archivos de Bronconeumología · doi:10.1016/j.arbr.2018.05.021 · Cited by 1
Toorens, D., Tombu, S., Camby, S., Rogister, F., Chakar, B., Fanielle, J., Bruwier, A., Lefebvre, P. P., & Poirrier, A. (2024) · Sleep And Breathing · doi:10.1007/s11325-024-03121-1 · Cited by 1
Aarab, G., & Lobbezoo, F. (2015) · Journal of Dental Sleep Medicine · doi:10.15331/jdsm.4628 · Cited by 1
Costs of Treatment Non-adherence in Obstructive Sleep Apnoea
O'Reilly, J. F. (2022) · Springer eBooks · doi:10.1007/978-3-030-93146-9_12 · Cited by 1
Position-Dependent Sleep Apnea: Implications for Diagnosis and Management
Bianchi, M. T. (2014) · Springer eBooks · doi:10.1007/978-3-319-09626-1_34
Kann die Telemedizin in der Schlafmedizin die Akzeptanz der nCPAP-Therapie verbessern?
Nilius, G., & Rühle, K.-H. (2014) · Der Pneumologe · doi:10.1007/s10405-013-0728-x
Brown, L. K. (2013) · CHEST Journal · doi:10.1378/chest.13-1698
Assessing Sleep Disorders in the Hispanic Patient
Loredo, J. (2013) · Springer eBooks · doi:10.1007/978-1-4614-4412-1_18
Sleep Apnea in Fragile X Syndrome: Case Report
Postol, K. (2015) · Journal of Dental Sleep Medicine · doi:10.15331/jdsm.4634
Significance of Occlusal Changes
Singh, G. D. (2015) · Journal of Dental Sleep Medicine · doi:10.15331/jdsm.4638
Impact of the ACA on Oral Appliance Therapy
Ziwot, D. (2015) · Journal of Dental Sleep Medicine · doi:10.15331/jdsm.4626
Challenges in Managing the Side Effects of Oral Appliance Therapy
Chahine, L. (2015) · Journal of Dental Sleep Medicine · doi:10.15331/jdsm.4636
Sleep Apnea Local Networks: Bridging the Communication Gaps
Groza, L. (2015) · Journal of Dental Sleep Medicine · doi:10.15331/jdsm.4640
Diagnostic Tools: The Easier, the Better
Poletti, R., Aimo, A., Castiglione, V., Gangi, A. D., Iudice, G., Micalizzi, M., Passino, C., & Emdin, M. (2016) · Springer eBooks · doi:10.1007/978-3-319-26354-0_10
Health-related Quality of Life in Patients with Sleep-Related Breathing Disorder
Heßmann, P., HEITMANN, J., Apelt, S., Balzer‐Geldsetzer, M., Dodel, R. C., & Mayer, G. (2017) · Journal of Sleep Disorders & Therapy · doi:10.4172/2167-0277.1000256
Research in Obstructive Sleep Disorders in Pediatrics
Nathanson, I. T. (2017) · CHEST Journal · doi:10.1016/j.chest.2017.02.015
Verbraecken, J. A. (2020) · Sleep Medicine X · doi:10.1016/j.sleepx.2020.100015
Jones, S. F. (2012) · Yearbook of Pulmonary Disease · doi:10.1016/j.ypdi.2012.02.029
AADSM 2015 Educational Calendar of Events
Staff, A. (2015) · Journal of Dental Sleep Medicine · doi:10.15331/jdsm.4642
Dort, L. C. (2015) · Journal of Dental Sleep Medicine · doi:10.15331/jdsm.4624
SANReSP: A new Italian questionnaire to screen patients for obstructive sleep apnea
Romano, S., Bue, A. L., Salvaggio, A., de Oliveira, L. V. F., Ferini‐Strambi, L., & Insalaco, G. (2022) · PLoS ONE · doi:10.1371/journal.pone.0276217
Xu, S., Li, Y., & Han, D.-M. (2024) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.11518
Braun, M., Schoebel, C., & Dietz-Terjung, S. (2026) · Somnologie - Schlafforschung und Schlafmedizin · doi:10.1007/s11818-026-00547-5
Detection of Obstructive Sleep Apnea Using Deep Learning on Audio Signals
Darquea, B., Vizcaíno-Imacaña, P., Criollo, S., Inga-Ipiales, A., Zhinín-Vera, L., Ramírez-Cando, L., Cadena-Morejón, C., Almeida-Galárraga, D. A., Tirado-Espín, A., & Villalba-Meneses, F. (2026) · Lecture notes in networks and systems · doi:10.1007/978-3-032-16995-2_17
Metadata
- Authors
- Pietzsch, J. B., Garner, A. M., Cipriano, L. E., & Linehan, J. H.
- Affiliations
- Stanford University (US)
- Northwestern University (US)
- Corresponding author
- John H. Linehan
- Venue
- Sleep
- Publisher
- Oxford University Press (OUP)
- Published
- 2011-06-01
- Volume
- 34
- Issue
- 6
- Pages
- 695-709
- ISSN
- 0161-8105 (ISSN-L)
- 1550-9109
- PMC
- PMC3098944
- OpenAlex
- W2085685282
- Cited by
- 149
- References
- 67
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 7 · 2023: 8 · 2022: 9 · 2021: 7 · 2020: 3 · 2019: 7 · 2018: 7 · 2017: 17 · 2016: 14 · 2015: 23 · 2014: 13 · 2013: 16 · 2012: 12
- FWCI
- 9.16
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- SLEEP (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Northwestern University
- Topics
- Health Sciences › Medicine › Physiology (medical) › Obstructive Sleep Apnea Research
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Keywords
- obstructive sleep apnea, cost-effectiveness, split-night polysomnography, home sleep apnea testing, continuous positive airway pressure, OSA diagnosis, quality-adjusted life years, Markov model
- MeSH terms
- Adult, Cost-Benefit Analysis, Female, Humans, Male, Markov Chains, Health Care Costs, Outcome Assessment, Health Care, Polysomnography, Quality-Adjusted Life Years, Sleep Apnea, Obstructive, Continuous Positive Airway Pressure
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
