Toraldo D M, Passali D, Sanna A, De Nuccio F, Conte L, De Benedetto M
Hospital Rehabilitation, Dept Cardio-Respiratory Care Unit, "V Fazzi", ASL Lecce, Italy.
ENT Clinic, University of Siena, Italy.
Acta Otorhinolaryngol Ital. 2017 Dec;37(6):447-453. doi: 10.14639/0392-100X-1520.
Obstructive sleep apnoea (OSAS) is an underdiagnosed chronic disease with a high prevalence in adults. It is becoming a significant social problem, since it is associated with a worsening in quality of life and increase in mortality. The cost-effectiveness ratio of diagnostic and therapeutic management of OSAS is a strategic issue to counteract the expected increasing demand of objective testing. OSAS patients with any clinical evidence of comorbidities must be studied using simplified and less expensive systems such as Home Sleep Testing (HST). On the other hand, Sleep Laboratory Polysomnography (PSG) is the gold standard to manage OSAS patients with comorbidities. It should be pointed out that the use of HST can lead to incorrect diagnosis in poorly selected OSAS subjects. This short review discusses various topics for the proper diagnosis and treatment of OSAS in view of epidemiological factors and results in terms of costs and social benefit of the disease. Whatever the strategy chosen and/or the organisational model adopted for managing OSAS, it cannot and should not take into account only cost-effectiveness. Long-term prospective studies evaluating cost-effectiveness ratios and outcomes of OSAS treatment of hospital management models versus home care models are needed.
阻塞性睡眠呼吸暂停（OSAS）是一种在成年人中普遍存在但未得到充分诊断的慢性疾病。它正成为一个重大的社会问题，因为它与生活质量下降和死亡率上升有关。OSAS诊断和治疗管理的成本效益比是应对客观测试预期需求增加的一个战略问题。对于有任何合并症临床证据的OSAS患者，必须使用诸如家庭睡眠测试（HST）等简化且成本较低的系统进行研究。另一方面，睡眠实验室多导睡眠图（PSG）是管理合并症OSAS患者的金标准。应该指出的是，在选择不当的OSAS受试者中使用HST可能会导致错误诊断。鉴于流行病学因素以及该疾病在成本和社会效益方面的结果，这篇简短综述讨论了OSAS正确诊断和治疗的各种主题。无论选择何种策略和/或采用何种组织模式来管理OSAS，都不能也不应该只考虑成本效益。需要进行长期前瞻性研究，评估医院管理模式与家庭护理模式治疗OSAS的成本效益比和结果。
