Pelletier-Fleury N, Meslier N, Gagnadoux F, Person C, Rakotonanahary D, Ouksel H, Fleury B, Racineux J L
Unité de Sommeil, Service de Pneumologie, CHU d'Angers, Angers, France.
Eur Respir J. 2004 Jan;23(1):53-60. doi: 10.1183/09031936.03.00066903.
The objective of this study was to measure the impact of a 6-month delay in the diagnosis and treatment of patients with moderate obstructive sleep apnoea syndrome (OSAS) (apnoea/hypopnoea index (AHI) < 30) or severe OSAS (AHI > or = 30) on daytime sleepiness, cognitive functions, quality of life and healthcare expenditure (hospitalisations, medical visits, complementary tests, biological tests and drug prescriptions). In addition, this study aimed to analyse the incremental cost effectiveness ratios related to daytime sleepiness or quality of life following immediate introduction of treatment in these two populations. This study was conducted as a multicentre randomised controlled trial and carried out at two teaching hospitals in France. A total of 171 patients were followed for 6 months, with 82 patients randomised to group 1 "immediate polysomnography" and 89 in group 2 "polysomnography within 6 months". Patients with severe OSAS were deprived of a significant improvement of their daytime sleepiness (5.1 +/- 5.0 at the Epworth Sleepiness Scale score in group 1 versus 0.2 +/- 3.4 in group 2) and quality of life (12.4 +/- 13.3 at the Nottingham Health Profile score in group 1 versus 0.7 +/- 10.1 in group 2) during the waiting time. The impact of delayed management in subjects with less severe OSAS only concerned daytime sleepiness (1.1 +/- 3.3 in group 1 versus 0.3 +/- 4.3 in group 2). Delayed treatment did not affect cognitive functions or healthcare expenditure regardless of the severity of the disease. Incremental cost effectiveness ratios related to rapid introduction of treatment were significantly lower in the patients with more severe OSAS. These results provide fairly clear medical and economic arguments in favour of early management of patients with more severe forms of obstructive sleep apnoea syndrome.
本研究的目的是评估中度阻塞性睡眠呼吸暂停综合征（OSAS）（呼吸暂停/低通气指数（AHI）<30）或重度OSAS（AHI>或=30）患者诊断和治疗延迟6个月对日间嗜睡、认知功能、生活质量和医疗费用（住院、就诊、辅助检查、生物检查和药物处方）的影响。此外，本研究旨在分析在这两个人群中立即开始治疗后与日间嗜睡或生活质量相关的增量成本效益比。本研究作为一项多中心随机对照试验，在法国的两家教学医院进行。共有171名患者随访6个月，82名患者随机分为第1组“立即进行多导睡眠图检查”，89名患者分为第2组“6个月内进行多导睡眠图检查”。重度OSAS患者在等待期间日间嗜睡（第1组Epworth嗜睡量表评分为5.1±5.0，第2组为0.2±3.4）和生活质量（第1组诺丁汉健康状况评分为12.4±13.3，第2组为0.7±10.1）未得到显著改善。轻度OSAS患者延迟治疗的影响仅涉及日间嗜睡（第1组为1.1±3.3，第2组为0.3±4.3）。无论疾病严重程度如何，延迟治疗均未影响认知功能或医疗费用。重度OSAS患者中与快速开始治疗相关的增量成本效益比显著更低。这些结果提供了相当明确的医学和经济依据，支持对更严重形式的阻塞性睡眠呼吸暂停综合征患者进行早期管理。
