Cost-Utility of Three Approaches to the Diagnosis of Sleep Apnea: Polysomnography, Home Testing, and Empirical Therapy

Chervin, Ronald D.; Murman, Daniel L.; Malow, Beth A.; Totten, Vicken Y.

doi:10.7326/0003-4819-130-6-199903160-00006

Cited by 129 publications

(76 citation statements)

References 20 publications

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“…Economic analyses have compared the cost-effectiveness of management pathways that incorporate diagnostic strategies using HSAT or PSG. [112][113][114] All have concluded that PSG is the preferred diagnostic strategy from an economic perspective for adults suspected to have moderate to severe OSA. An important factor in these analyses is the favorable cost-effectiveness of OSA treatment in patients with moderate to severe OSA, particularly when longer time horizons are considered.…”

Section: Quality Of Lifementioning

confidence: 99%

Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline

Kapur

Auckley

Chowdhuri

et al. 2017

Journal of Clinical Sleep Medicine

2,135

1,498

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Introduction: This guideline establishes clinical practice recommendations for the diagnosis of obstructive sleep apnea (OSA) in adults and is intended for use in conjunction with other American Academy of Sleep Medicine (AASM) guidelines on the evaluation and treatment of sleep-disordered breathing in adults. Methods: The AASM commissioned a task force of experts in sleep medicine. A systematic review was conducted to identify studies, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process was used to assess the evidence. The task force developed recommendations and assigned strengths based on the quality of evidence, the balance of benefits and harms, patient values and preferences, and resource use. In addition, the task force adopted foundational recommendations from prior guidelines as "good practice statements", that establish the basis for appropriate and effective diagnosis of OSA. The AASM Board of Directors approved the final recommendations. Recommendations:The following recommendations are intended as a guide for clinicians diagnosing OSA in adults. Under GRADE, a STRONG recommendation is one that clinicians should follow under most circumstances. A WEAK recommendation reflects a lower degree of certainty regarding the outcome and appropriateness of the patient-care strategy for all patients. The ultimate judgment regarding propriety of any specific care must be made by the clinician in light of the individual circumstances presented by the patient, available diagnostic tools, accessible treatment options, and resources. Good Practice Statements:Diagnostic testing for OSA should be performed in conjunction with a comprehensive sleep evaluation and adequate follow-up. Polysomnography is the standard diagnostic test for the diagnosis of OSA in adult patients in whom there is a concern for OSA based on a comprehensive sleep evaluation. Recommendations:1. We recommend that clinical tools, questionnaires and prediction algorithms not be used to diagnose OSA in adults, in the absence of polysomnography or home sleep apnea testing. (STRONG) 2. We recommend that polysomnography, or home sleep apnea testing with a technically adequate device, be used for the diagnosis of OSA in uncomplicated adult patients presenting with signs and symptoms that indicate an increased risk of moderate to severe OSA. (STRONG) 3. We recommend that if a single home sleep apnea test is negative, inconclusive, or technically inadequate, polysomnography be performed for the diagnosis of OSA. (STRONG) 4. We recommend that polysomnography, rather than home sleep apnea testing, be used for the diagnosis of OSA in patients with significant cardiorespiratory disease, potential respiratory muscle weakness due to neuromuscular condition, awake hypoventilation or suspicion of sleep related hypoventilation, chronic opioid medication use, history of stroke or severe insomnia. (STRONG) 5. We suggest that, if clinically appropriate, a split-night diagnostic protocol, rather than a full-night diagnostic protoc...

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Section: Quality Of Lifementioning

confidence: 99%

Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline

Kapur

Auckley

Chowdhuri

et al. 2017

Journal of Clinical Sleep Medicine

2,135

1,498

View full text Add to dashboard Cite

show abstract

“…We compare our results to those of Chervin et al (40), who conducted a cost-utility analysis of polysomnography, not testing at all, and home diagnostic testing using portable monitors in a hypothetical cohort of patients suspected of having OSAS, presumably such as those referred to a sleep center. Treatment was offered not only to the subset with confirmed OSAS on home study or polysomnography, but to everyone in the "no-testing" group.…”

Section: Discussionmentioning

confidence: 62%

“…Given the paucity of data regarding longer-term health outcomes and costs, our analysis assessed costs of diagnosis and treatment of sleep apnea which occur within the first year, when these costs are presumably the highest (40). One study has addressed this issue in a more general population.…”

Section: Discussionmentioning

confidence: 99%

Estimated cost of crashes in commercial drivers supports screening and treatment of obstructive sleep apnea

Gurubhagavatula

Nkwuo

Maislin

et al. 2008

Accident Analysis & Prevention

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Sleep apnea among commercial drivers may increase the risk of fall-asleep crashes, which incur large expenses. Drivers of passenger cars whose apnea is treated experience lower crash risk. Among community-based holders of commercial driver's licenses, we considered three methods for identifying sleep apnea syndrome: 1) in-lab polysomnography; 2) selective in-lab polysomnography for high-risk drivers, where high risk is first identified by body mass index, age and gender, followed by oximetry in a subset of drivers; and 3) not screening. The costs for each of these three programs equaled the sum of the costs of testing, treatment of identified cases, and crashes. Assuming that treatment prevents apnea-related crashes, polysomnography is not costeffective, because it was more expensive than the cost of crashes when no screening is done. Screening with BMI, age and gender, however, with confirmatory in-lab polysomnography only on high-risk drivers was cost-effective, as long as a high proportion (73.8%) of screened drivers accepts treatment. These findings indicate that strategies that reduce reliance on in-laboratory polysomnography may be more cost-effective than not screening, and that treatment acceptance may need to be a condition of employment for affected drivers.

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“…However, there have been only a few randomized clinical trials involving different strategies for the diagnosis and treatment of OSAS that include the collection of data about quality of life, health, and economic aspects. (57)(58)(59)(60) One review, (57) using a model for the cost-utility analysis, comparing laboratory polysomnography, in-home monitoring, and no testing for five years after the initial evaluation for OSAS, including CPAP therapy, involved a hypothetical cohort of individuals suspected of having OSAS. Quality of life, survival, and charges for (as proxies for costs of) each diagnostic method were considered.…”

Section: Cost-effectiveness Of the Use Of Pmdsmentioning

confidence: 99%

Monitorização portátil no diagnóstico da apneia obstrutiva do sono: situação atual, vantagens e limitações

et al. 2010

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Recent years have seen a growing interest in the use of portable monitoring devices for the diagnosis of obstructive sleep apnea syndrome. These have the potential to be used in lieu of the more complicated and uncomfortable alternative, polysomnography, which has long been considered to be the gold standard for the diagnosis of this relatively prevalent condition. Following their approval in 2008 by the Center of Medicare and Medicaid Services, the federal agency which administers Medicare and Medicaid in the United States, there has been extensive discussion about the utility and validity of these devices for use in the diagnosis of obstructive sleep apnea syndrome. Although there are various models of portable monitoring devices, the literature contains little information regarding how each device should be used in specific age groups, patients presenting comorbidities, and asymptomatic patients. Additionally, studies about the cost-effectiveness of this diagnostic method are scarce and conflicting. Therefore, this objective of this study was to review what has been learned about portable monitoring devices over time, as well as to examine the recent progress, advantages, limitations, and applications of these devices in the diagnosis of obstructive sleep apnea syndrome in different groups of patients.Keywords: Sleep apnea, obstructive/diagnosis; Polysomnography; Diagnostic equipment; Monitoring, ambulatory. ResumoNos últimos anos, é crescente o interesse pela utilização de aparelhos de monitoramento portáteis para o diagnóstico da síndrome da apneia obstrutiva do sono, como uma alternativa mais simples e confortável à polissonografia, que é o exame considerado o padrão ouro para o diagnóstico dessa condição relativamente prevalente. A liberação do uso desses equipamentos pelo Center of Medicare and Medicaid Services, agência federal que administra os serviços médicos nos Estados Unidos da América, em 2008, resultou em ampla discussão sobre a utilidade e validade desses equipamentos para o diagnóstico de síndrome da apneia obstrutiva do sono. Apesar de haver vários modelos de equipamentos de monitorização portátil, há pouca informação na literatura a respeito de como cada equipamento deveria ser utilizado em grupos etários específicos, portadores de comorbidades e pacientes assintomáticos. Além disso, estudos de custo-efetividade desse método diagnóstico são escassos e conflitantes. Portanto, o objetivo do presente estudo foi revisar a evolução dos conhecimentos no uso de equipamentos de monitorização portátil, bem como examinar os avanços recentes, vantagens, limitações e aplicações desses equipamentos para o diagnóstico de apneia obstrutiva do sono em diferentes grupos de pacientes.Descritores: Apneia do sono tipo obstrutiva/diagnóstico; Polissonografia; Equipamentos para diagnóstico; Monitorização ambulatorial.

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Cost-Utility of Three Approaches to the Diagnosis of Sleep Apnea: Polysomnography, Home Testing, and Empirical Therapy

Cited by 129 publications

References 20 publications

Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline

Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline

Estimated cost of crashes in commercial drivers supports screening and treatment of obstructive sleep apnea

Monitorização portátil no diagnóstico da apneia obstrutiva do sono: situação atual, vantagens e limitações

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