Effectiveness of sequential automatic-manual home respiratory polygraphy scoring

Abstract

Automatic home respiratory polygraphy (HRP) scoring functions can potentially confirm the diagnosis of sleep apnoea-hypopnoea syndrome (SAHS) (obviating technician scoring) in a substantial number of patients. The result would have important management and cost implications. The aim of this study was to determine the diagnostic cost-effectiveness of a sequential HRP scoring protocol (automatic and then manual for residual cases) compared with manual HRP scoring, and with in-hospital polysomnography.We included suspected SAHS patients in a multicentre study and assigned them to home and hospital protocols at random. We constructed receiver operating characteristic (ROC) curves for manual and automatic scoring. Diagnostic agreement for several cut-off points was explored and costs for two equally effective alternatives were calculated.Of 366 randomised patients, 348 completed the protocol. Manual scoring produced better ROC curves than automatic scoring. There was no sensitive automatic or subsequent manual HRP apnoea-hypopnoea index (AHI) cut-off point. The specific cut-off points for automatic and subsequent manual HRP scorings (AHI .25 and .20, respectively) had a specificity of 93% for automatic and 94% for manual scorings. The costs of manual protocol were 9% higher than sequential HRP protocol; these were 69% and 64%, respectively, of the cost of the polysomnography.A sequential HRP scoring protocol is a cost-effective alternative to polysomnography, although with limited cost savings compared to HRP manual scoring.

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

“…67,86 Seven studies evaluated the performance of Type 3 HSAT devices against PSG, but the AHI cutoffs employed varied across studies, resulting in sub-grouping by AHI cutoffs for our analyses. [87][88][89][90][91][92][93] When using an AHI ≥ 5 cutoff, accuracy in a high-risk population (assuming a prevalence of 87%) ranged from 84% to 91%, whereas in a low-risk population (assuming a prevalence of 55%) accuracy ranged from 70% to 78% based on the seven studies (see supplemental material, Table S39). Using a cutoff of AHI ≥ 15, the accuracy of these devices in a high-risk population ranged from 65% to 91%, based on six studies 87,[89][90][91][92]94 (see supplemental material, Table S40).…”

“…35,53,54,81,86,88,93,96,116 The required signals and minimum durations included nasal pressure flow and oximetry for at least 3 hours 88,93,116 or 4 hours 53,81,86,96 and single-channel nasal airflow recording for a minimum of 3 hours 35 or only 2 hours. 54 The diagnostic accuracy of the cardiorespiratory devices compared against PSG for the detection of OSA at different AHI cutoff points was relatively high.…”

Effectiveness of Home Single-Channel Nasal Pressure for Sleep Apnea Diagnosis

“…37 One of the aforementioned similar studies 12 used the "alternative" definition from the American Academy of Sleep Medicine 2007, and its prevalence was close to ours (for an AHI ≥ 10, theirs was 79%, and ours was 84%); in two other papers studying single-channel nasal pressure device, measured simultaneously with in-laboratory PSG, the prevalence for AHI ≥ 5 was 94% 38 and 85%, respectively. 9,20 Furthermore, another Spanish study with a similar methodology for home respiratory polygraphy and the same hypopnea definition found an OSA prevalence of 90%. 10 Therefore, our hypopnea definition could explain, at least in part, the higher OSA prevalence found in our study.…”

“…Moreover, all but one 19 of these studies scored the respiratory events automatically. While automatic scoring is simpler, manual scoring has greater agreement with PSG for respiratory polygraphy, 20 and also for a single-channel nasal pressure device measured simultaneously with in-laboratory PSG. 21,22 OSA is normally considered when the polysomnographic apnea and hypopnea index (AHI) is ≥ 5, 23-29 although higher cutoff points (≥ 10 or ≥ 15) are also commonly used for diagnosing.…”

Ambulatory monitoring in the diagnosis and management of obstructive sleep apnoea syndrome

“…Manual scoring is superior to automated scoring [39]. The sequential RP scoring protocol had a similar cost to manual scoring and both were a cheaper alternative to PSG [36,37,39].…”