Golpe Rafael, Jiménez Antonio, Carpizo Rosario
Sleep Disorders Unit, Marqués de Valdecilla University Hospital, University of Cantabria, Santander, Spain.
Chest. 2002 Oct;122(4):1156-61. doi: 10.1378/chest.122.4.1156.
To determine the clinical utility of a limited sleep-recording device used unsupervised in the patient's home, compared with in-laboratory, fully supervised polysomnography for the diagnosis of sleep apnea/hypopnea syndrome (SAHS), and to assess its impact on costs.
Prospective case study.
The sleep-disorders unit of a tertiary referral university hospital.
Fifty-five patients suspected of having SAHS and living within 30 km of our laboratory.
Patients were studied first in their homes with the limited sleep-recording device. Polysomnography was performed within 30 days of the first study. Both studies were read by independent investigators blinded to the results of the other study. Diagnoses and therapeutic decisions regarding the use of continuous positive airway pressure obtained from the home and laboratory studies were compared. Agreement between the home and laboratory study recordings was also assessed using receiver operating characteristic (ROC) curves and Bland-Altman analysis. One half of the home studies were randomly assigned to be performed with a sleep technician's set up of the equipment in the patient's home (group 1), and the other half with the patient's own setup of the sleep-recording device (group 2), after an instruction period in the hospital. An economic analysis was performed, considering the cost of repeating studies in cases with faulty or inconclusive home studies (these patients should undergo polysomnography as a second step).
Seven percent of the home studies in group 1, and 33% in group 2 produced no interpretable data because of artifacts (p < 0.05). Sixteen percent of the home study findings were inconclusive. The diagnosis obtained from the limited sleep-recording device and polysomnography agreed in 75% of the interpretable home studies (89%, if inconclusive home studies were excluded). The area under the ROC curve for the home study-derived parameters was between 0.84 and 0.89, compared with polysomnography. There was no bias between home and polysomnography studies in the Bland-Altman plot. The cost per study of home study recordings was less expensive than that of polysomnography (143.86 euros), either with (93.08 euros) or without (129.97 euros) intervention of the technician in the patient's home.
Home sleep studies are a viable form of diagnosing SAHS, and are less expensive than polysomnography. Intervention of a sleep technician in the patient's home was the least expensive strategy, because of the high percentages of faulty studies with the patient's own setup of the equipment, when using the limited sleep-recording device.
与在实验室进行的、有全程监督的多导睡眠图检查相比，确定患者在家中无监督使用的有限睡眠记录设备对诊断睡眠呼吸暂停/低通气综合征（SAHS）的临床实用性，并评估其对成本的影响。
前瞻性病例研究。
一所三级转诊大学医院的睡眠障碍科。
55名怀疑患有SAHS且居住在距我们实验室30公里范围内的患者。
首先让患者在家中使用有限睡眠记录设备进行研究。在首次研究后的30天内进行多导睡眠图检查。两项研究均由对另一项研究结果不知情的独立研究人员解读。比较从家庭和实验室研究中获得的关于使用持续气道正压通气的诊断和治疗决策。还使用受试者工作特征（ROC）曲线和Bland-Altman分析评估家庭和实验室研究记录之间的一致性。在医院经过指导期后，将一半的家庭研究随机分配为由睡眠技术人员在患者家中设置设备进行（第1组），另一半由患者自己设置睡眠记录设备进行（第2组）。进行了经济分析，考虑了家庭研究结果错误或不确定的情况下重复研究的成本（这些患者应作为第二步进行多导睡眠图检查）。
第1组家庭研究中有7%，第2组中有33%由于伪差未产生可解读的数据（p<0.05）。16%的家庭研究结果不确定。在75%可解读的家庭研究中，有限睡眠记录设备得出的诊断与多导睡眠图检查一致（如果排除不确定的家庭研究，则为89%）。与多导睡眠图检查相比，家庭研究得出的参数的ROC曲线下面积在0.84至0.89之间。在Bland-Altman图中，家庭和多导睡眠图检查之间没有偏差。无论是否有技术人员在患者家中进行干预，家庭研究记录每次检查的成本都比多导睡眠图检查便宜（多导睡眠图检查为143.86欧元），有技术人员干预时家庭研究记录每次检查的成本为93.08欧元，无技术人员干预时为129.97欧元。
家庭睡眠研究是诊断SAHS的一种可行形式，且比多导睡眠图检查成本更低。当使用有限睡眠记录设备时，由于患者自己设置设备导致研究错误的比例较高，因此睡眠技术人员在患者家中进行干预是成本最低的策略。
