• Juan F Masa, Jaime Corral, Julio Sanchez de Cos, Joaquin Duran-Cantolla, Marta Cabello, Luis Hernández-Blasco, Carmen Monasterio, Alberto Alonso, Eusebi Chiner, Felipe Aizpuru, Francisco-José Vázquez-Polo, Jose Zamorano, Jose M Montserrat, Collaborating group:, Estefania Garcia-Ledesma, Ricardo Pereira, Laura Cancelo, Angeles Martinez, Lirios Sacristan, Neus Salord, Miguel Carrera, José N Sancho-Chust, Miguel A Negrín, and Cristina Embid.
• San Pedro de Alcantara Hospital, Caceres, Spain ; CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain.
• Sleep. 2013 Dec 1;36(12):1799-807.

RationaleHome respiratory polygraphy (HRP) may be a cost-effective alternative to polysomnography (PSG) for diagnosis and treatment election in patients with high clinical probability of obstructive sleep apnea (OSA), but there is conflicting evidence on its use for a wider spectrum of patients.ObjectivesTo determine the efficacy and cost of OSA management (diagnosis and therapeutic decision making) using (1) PSG for all patients (PSG arm); (2) HRP for all patients (HRP arm); and (3) HRP for a subsample of patients with high clinical probability of being treated with continuous positive airway pressure (CPAP) and PSG for the remainder (elective HRP arm).MethodsMulticentric study of 366 patients with intermediate-high clinical probability of OSA, randomly subjected to HRP and PSG. We explored the diagnostic and therapeutic decision agreements between the PSG and both HRP arms for several HRP cutoff points and calculated costs for equal diagnostic and/or therapeutic decision efficacy.ResultsFor equal diagnostic and therapeutic decision efficacy, PSG arm costs were 18% higher than HRP arm costs and 20% higher than elective HRP arm costs. HRP arm costs tended to be lower than elective HRP arm costs, and both tended to be lower than PSG arm costs if patient costs were omitted.ConclusionHome respiratory polygraphy is a less costly alternative than polysomnography for the diagnosis and therapeutic decision making for patients with suspected obstructive sleep apnea. We found no advantage in cost terms, however, in using home respiratory polygraphy for all patients or home respiratory polygraphy for the most symptomatic patients and polysomnography for the rest.

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