Economic evaluation of diagnostic sleep studies for obstructive sleep apnoea: a systematic review protocol

Natsky, Andrea N.; Vakulin, Andrew; Coetzer, Ching Li Chai; McEvoy, R. Doug; Adams, Robert; Kaambwa, Billingsley

doi:10.1186/s13643-021-01651-3

Cited by 13 publications

(15 citation statements)

References 58 publications

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“…Several small single‐center studies have found clinical screening with subsequent selection for PSG to be more cost‐effective in deciding subsequent management 75 . A systematic review on the economic evaluation of diagnostic tests for OSA is underway, where the cost‐effectiveness of limited channel tests compared with PSG in the diagnosis of OSA will be conducted 76 . Ultimately, there is not a one‐size‐fit‐all strategy, and each region or country has to decide on the most appropriate screening strategy based on resource availability, OSA prevalence, and healthcare funding priorities.…”

Section: Discussionmentioning

confidence: 99%

Screening for obstructive sleep apnea (OSA) in children and adolescents with obesity: A scoping review of national and international pediatric obesity and pediatric OSA management guidelines

Ng,

Lim,

Tan

et al. 2024

Obesity Reviews

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SummaryObstructive sleep apnea (OSA) is a prevalent complication that affects up to 60% of children and adolescents with obesity. It is associated with poorer cardiometabolic outcomes and neurocognitive deficits. Appropriate screening and intervention for OSA are crucial in the management of children with obesity. We performed a scoping review of international and national pediatric obesity (n = 30) and pediatric OSA (n = 10) management guidelines to evaluate the recommendations on OSA screening in pediatric obesity. Sixteen (53%) of the pediatric obesity guidelines had incorporated OSA screening to varying extents, with no consistent recommendations on when and how to screen for OSA, and subsequent management of OSA in children with obesity. We provide our recommendations that are based on the strength and certainty of evidence presented. These include a clinical‐based screening for OSA in all children with body mass index (BMI) ≥ 85th percentile or those with rapid BMI gain (upward crossing of 2 BMI percentiles) and the use of overnight polysomnography to confirm the diagnosis of OSA in those with high clinical suspicion. We discuss further management of OSA unique to children with obesity. An appropriate screening strategy for OSA would facilitate timely intervention that has been shown to improve cardiometabolic and neurocognitive outcomes.

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Section: Discussionmentioning

confidence: 99%

Screening for obstructive sleep apnea (OSA) in children and adolescents with obesity: A scoping review of national and international pediatric obesity and pediatric OSA management guidelines

Ng,

Lim,

Tan

et al. 2024

Obesity Reviews

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“…The advantages of using home-recorded data include reduced patient stresses, associated with travel and overnight hospital stays, plus a potential reduction in waiting times and clinical costs ( Collop et al, 2007 ). A systematic review is currently underway to determine the cost-effectiveness of limited channel tests compared to laboratory and home PSG in diagnosing OSA ( Natsky et al, 2021 ). Empirical studies support the use of limited channel tests carried out in the patients’ own home, suggesting similar efficacy, at lower costs, compared to PSG ( Masa et al, 2014 ; Corral et al, 2017 ).…”

Section: Discussionmentioning

confidence: 99%

Diagnosis of Sleep Apnoea Using a Mandibular Monitor and Machine Learning Analysis: One-Night Agreement Compared to in-Home Polysomnography

et al. 2022

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BackgroundThe capacity to diagnose obstructive sleep apnoea (OSA) must be expanded to meet an estimated disease burden of nearly one billion people worldwide. Validated alternatives to the gold standard polysomnography (PSG) will improve access to testing and treatment. This study aimed to evaluate the diagnosis of OSA, using measurements of mandibular movement (MM) combined with automated machine learning analysis, compared to in-home PSG.Methods40 suspected OSA patients underwent single overnight in-home sleep testing with PSG (Nox A1, ResMed, Australia) and simultaneous MM monitoring (Sunrise, Sunrise SA, Belgium). PSG recordings were manually analysed by two expert sleep centres (Grenoble and London); MM analysis was automated. The Obstructive Respiratory Disturbance Index calculated from the MM monitoring (MM-ORDI) was compared to the PSG (PSG-ORDI) using intraclass correlation coefficient and Bland-Altman analysis. Receiver operating characteristic curves (ROC) were constructed to optimise the diagnostic performance of the MM monitor at different PSG-ORDI thresholds (5, 15, and 30 events/hour).Results31 patients were included in the analysis (58% men; mean (SD) age: 48 (15) years; BMI: 30.4 (7.6) kg/m2). Good agreement was observed between MM-ORDI and PSG-ORDI (median bias 0.00; 95% CI −23.25 to + 9.73 events/hour). However, for 15 patients with no or mild OSA, MM monitoring overestimated disease severity (PSG-ORDI < 5: MM-ORDI mean overestimation + 5.58 (95% CI + 2.03 to + 7.46) events/hour; PSG-ORDI > 5–15: MM-ORDI overestimation + 3.70 (95% CI −0.53 to + 18.32) events/hour). In 16 patients with moderate-severe OSA (n = 9 with PSG-ORDI 15–30 events/h and n = 7 with a PSG-ORD > 30 events/h), there was an underestimation (PSG-ORDI > 15: MM-ORDI underestimation −8.70 (95% CI −28.46 to + 4.01) events/hour). ROC optimal cut-off values for PSG-ORDI thresholds of 5, 15, 30 events/hour were: 9.53, 12.65 and 24.81 events/hour, respectively. These cut-off values yielded a sensitivity of 88, 100 and 79%, and a specificity of 100, 75, 96%. The positive predictive values were: 100, 80, 95% and the negative predictive values 89, 100, 82%, respectively.ConclusionThe diagnosis of OSA, using MM with machine learning analysis, is comparable to manually scored in-home PSG. Therefore, this novel monitor could be a convenient diagnostic tool that can easily be used in the patients’ own home.Clinical Trial Registrationhttps://clinicaltrials.gov, identifier NCT04262557

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“…Por ejemplo, en España no se han publicado estudios del coste social de esta patología, pero se estima que hay entre 1. 200.000 y 2.150.000 casos de SAOS, de los cuales solo el 25% están tratados (27). Además, su diagnóstico es importante porque su tratamiento permite una mejora de la calidad de vida, la reducción las tasas de accidentes automovilísticos y el riesgo de las complicaciones crónicas mencionadas anteriormente.…”

Section: Diagnóstico Del Saos Y Tipos De Estudios Del Sueñounclassified

“…La PSG se considera el estándar de oro para detectar casos de SAOS; sin embargo, es cara, requiere mucho tiempo y con frecuencia es inaccesible. Por lo tanto, se necesitan pruebas alternativas para realizar una preselección de casos potenciales (189,199,200).…”

Section: Resumen De La Evidenciaunclassified

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Análisis de los métodos más eficaces para el cribado del síndrome de apnea obstructiva del sueño en la clínica dental

Rossi¹

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Introduction: Obstructive sleep apnea (OSA) is a sleep-related breathing disorder, that determines severe sequelae on affected people's health. The gold standard to diagnose OSA is the polysomnography, which however is expensive, time-consuming, laborintensive and not always available. Therefore, OSA is underdiagnosed, and thus, given the severity of its consequences, it represents a significant burden for the health system.To solve this problem easy-to-perform screening methods are needed to identify subjects at high risk of OSA. Dentists are particularly well placed to carry out this initial tests.Objective: To review the available bibliographic data to identify the best screening methods to detect potential OSA patients during dental clinical practice, both for adults and children. Methods:Relevant studies published up to April 2021 were sourced from PubMed, Embase, MEDLINE, Cochrane, and LILACS databases.Results: 93 studies were selected, 52 for adults and 41 for children. The screening methods available to the dentist included questionnaires, pulse oximetry, analyses of the upper airways and anatomical factors. Some of these were found to be adequate tools for certain specific purposes, but none of them presented all the characteristics required to be considered a good screening method for OSA on a standalone basis. It is thus necessary to combine multiple of them to achieve a sufficient precision in OSA detection. This is supported by some of the reviewed studies, but it should be further researched.Dentists have a fundamental role in early detection of potential OSA cases since they can use the methods described in this review to perform an initial screening of the population and address the identified subjects to sleep physicians. Sleep Apnea Clinical Score Flemons WW y cols. (62) 1994 4 + tabla de putuación Cuestionario es el de Berlín (CB) Conferencia sobre el sueño en atención primaria celebrada en Berlín. (63) 1996 11 Escala NOSE Stewart MG y cols. (66) 2004 ASA checklist Grupo de trabajo de la Sociedad Americana de Anestesiólogos. (68) 2006 12 Apnea Risk Evaluation System (ARES) Levendowski DJ y cols. (69) 2007 5 + EES STOP Chung F y cols. (70) 2008 STOP-Bang Chung F y cols. (70) 2008 Four-Variable Screening Tool (4-VST) Takegami M y cols. (71) 2009 Ecuación de 4 variables.

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Economic evaluation of diagnostic sleep studies for obstructive sleep apnoea: a systematic review protocol

Cited by 13 publications

References 58 publications

Screening for obstructive sleep apnea (OSA) in children and adolescents with obesity: A scoping review of national and international pediatric obesity and pediatric OSA management guidelines

Screening for obstructive sleep apnea (OSA) in children and adolescents with obesity: A scoping review of national and international pediatric obesity and pediatric OSA management guidelines

Diagnosis of Sleep Apnoea Using a Mandibular Monitor and Machine Learning Analysis: One-Night Agreement Compared to in-Home Polysomnography

Análisis de los métodos más eficaces para el cribado del síndrome de apnea obstructiva del sueño en la clínica dental

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