Xu Shenglong, Li Yanru, Han Demin
Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
Obstructive Sleep Apnea-Hypopnea Syndrome Clinical Diagnosis and Therapy and Research Centre, Capital Medical University, Beijing, China.
J Clin Sleep Med. 2025 Apr 1;21(4):655-665. doi: 10.5664/jcsm.11518.
Obstructive sleep apnea (OSA) is a common disorder in the pediatric population, primarily diagnosed through polysomnography (PSG). However, PSG can be expensive and is often limited in availability. This study aimed to develop a cost-effective diagnostic strategy by integrating a screening model with PSG.
A retrospective analysis was conducted on children suspected of OSA. Screening models were initially constructed with machine learning techniques. Cost-utility analyses compared 3 diagnostic strategies: (1) PSG alone, (2) the screening model alone, and (3) the screening model-PSG combined, in the discovery and validation cohorts. Cost-utility was measured using the incremental net monetary benefit.
A total of 690 children were included. The logistic regression model using age, tonsil scale, OSA questionnaire-18 questions 1 and 2, and oxygen desaturation index 3% predicted OSA with an area under the curve of 0.91. In the cost-utility analysis, the "PSG alone" strategy, as the baseline, was the most beneficial (utility 0.9557) at Chinese yuan (CNY) 4,523.98. The "screening model alone" had 91.6% sensitivity and 59.3% specificity, offering lesser value (utility 0.9337) at CNY 6,071.51 (incremental net monetary benefit CNY -3,966.43) when compared to "PSG alone." The "screening model-PSG combined" strategy increased sensitivity to 100%, specificity to 99.2%, and utility to 0.9554 at CNY 4,463.36, establishing it as the most cost-effective option with an incremental net monetary benefit of CNY 34.22. One-way sensitivity analyses and adaptation to United States cost parameters confirmed the robustness of these results.
Using the screening model as a triage tool for PSG enhances the cost-effectiveness of pediatric OSA management.
Xu S, Li Y, Han D. Cost-utility analysis of a tiered diagnostic approach combining a screening model and polysomnography in pediatric obstructive sleep apnea. . 2025;21(4):655-665.
阻塞性睡眠呼吸暂停（OSA）是儿科人群中的常见疾病，主要通过多导睡眠图（PSG）进行诊断。然而，PSG成本高昂且可用性往往有限。本研究旨在通过将筛查模型与PSG相结合，制定一种具有成本效益的诊断策略。
对疑似OSA的儿童进行回顾性分析。最初使用机器学习技术构建筛查模型。成本效用分析在发现队列和验证队列中比较了三种诊断策略：（1）仅PSG，（2）仅筛查模型，（3）筛查模型与PSG相结合。使用增量净货币效益来衡量成本效用。
共纳入690名儿童。使用年龄、扁桃体分度、OSA问卷18个问题中的问题1和问题2以及氧饱和度下降指数3%的逻辑回归模型预测OSA的曲线下面积为0.91。在成本效用分析中，以“仅PSG”策略为基线，其在人民币4523.98元时最具效益（效用为0.9557）。“仅筛查模型”的灵敏度为91.6%，特异度为59.3%，与“仅PSG”相比，在人民币6071.51元时价值较低（效用为0.9337）（增量净货币效益为人民币-3966.43元）。“筛查模型与PSG相结合”策略的灵敏度提高到100%，特异度提高到99.2%，在人民币4463.36元时效用提高到0.9554，成为最具成本效益的选择，增量净货币效益为人民币34.22元。单向灵敏度分析以及对美国成本参数的调整证实了这些结果的稳健性。
将筛查模型用作PSG的分诊工具可提高儿科OSA管理的成本效益。
Xu S, Li Y, Han D. Cost-utility analysis of a tiered diagnostic approach combining a screening model and polysomnography in pediatric obstructive sleep apnea.. 2025;21(4):655-665.
