• Juan F Masa, Joaquin Duran-Cantolla, Francisco Capote, Marta Cabello, Jorge Abad, Francisco Garcia-Rio, Antoni Ferrer, Merche Mayos, Nicolas Gonzalez-Mangado, Monica de la Peña, Felipe Aizpuru, Ferran Barbe, Jose M Montserrat, Spanish Sleep Network, Luis D Larrateguy, Jorge Rey de Castro, Estefania Garcia-Ledesma, Isabel Utrabo, Jaime Corral, Cristina Martinez-Null, Carlos Egea, Laura Cancelo, Emilio García-Díaz, Carmen Carmona-Bernal, Angeles Sánchez-Armengol, Ana M Fortuna, Rosa M Miralda, Maria F Troncoso, Gonzalez Monica, Marian Martinez-Martinez, Olga Cantalejo, Javier Piérola, Laura Vigil, Cristina Embid, Mireia Del Mar Centelles, Teresa Ramírez Prieto, Blas Rojo, and Lores Vanesa.
• San Pedro de Alcantara Hospital, Caceres, Spain and CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain: CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain.
• Sleep. 2014 Dec 1;37(12):1953-61.

IntroductionHome single-channel nasal pressure (HNP) may be an alternative to polysomnography (PSG) for obstructive sleep apnea (OSA) diagnosis, but no cost studies have yet been carried out. Automatic scoring is simpler but generally less effective than manual scoring.ObjectivesTo determine the diagnostic efficacy and cost of both scorings (automatic and manual) compared with PSG, taking as a polysomnographic OSA diagnosis several apnea-hypopnea index (AHI) cutoff points.MethodsWe included suspected OSA patients in a multicenter study. They were randomized to home and hospital protocols. We constructed receiver operating characteristic (ROC) curves for both scorings. Diagnostic efficacy was explored for several HNP AHI cutoff points, and costs were calculated for equally effective alternatives.ResultsOf 787 randomized patients, 752 underwent HNP. Manual scoring produced better ROC curves than automatic for AHI < 15; similar curves were obtained for AHI ≥ 15. A valid HNP with manual scoring would determine the presence of OSA (or otherwise) in 90% of patients with a polysomnographic AHI ≥ 5 cutoff point, in 74% of patients with a polysomnographic AHI ≥ 10 cutoff point, and in 61% of patients with a polysomnographic AHI ≥ 15 cutoff point. In the same way, a valid HNP with automatic scoring would determine the presence of OSA (or otherwise) in 73% of patients with a polysomnographic AHI ≥ 5 cutoff point, in 64% of patients with a polysomnographic AHI ≥ 10 cutoff point, and in 57% of patients with a polysomnographic AHI ≥ 15 cutoff point. The costs of either HNP approaches were 40% to 70% lower than those of PSG at the same level of diagnostic efficacy. Manual HNP had the lowest cost for low polysomnographic AHI levels (≥ 5 and ≥ 10), and manual and automatic scorings had similar costs for higher polysomnographic cutoff points (AHI ≥ 15) of diagnosis.ConclusionHome single-channel nasal pressure (HNP) is a cheaper alternative than polysomnography for obstructive sleep apnea diagnosis. HNP with manual scoring seems to have better diagnostic accuracy and a lower cost than automatic scoring for patients with low apnea-hypopnea index (AHI) levels, although automatic scoring has similar diagnostic accuracy and cost as manual scoring for intermediate and high AHI levels. Therefore, automatic scoring can be appropriately used, although diagnostic efficacy could improve if we carried out manual scoring on patients with AHI < 15.Clinical Trials InformationClinicaltrials.gov identifier: NCT01347398.© 2014 Associated Professional Sleep Societies, LLC.

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