SHOULD PATIENTS WITH SLEEP APNOEA HYPOPNOEA SYNDROME BE DIAGNOSED ANDMANAGED ON THE BASIS OF HORNE SLEEP STUDIES/

The purpose of this study was to analyse the validity and the economic efficiency of a portable monitor of respiratory parameters (PMRP), us ed in a home setting for the diagnosis of sleep apnoea/hypopnoea syndr ome (SAHS). Eighty nine patients with suspected SAHS were studied in t wo settings: in the sleep laboratory using full-polysomnography (full- PSG); and st the patient's home using a PMRP. In the home setting, 50 patients were assisted by a technician and 39 set up the equipment the mselves. SAHS (apnoea/hypopnoea index (AHI) >10 events.h(-1) by means of full-PSG) was diagnosed in 75 of the 89 patients. An acceptable agr eement was obtained between the AHI measured by full-PSG and PMRP, acc ording to the Bland and Altman method of concordance (mean bias 2.56; 95% confidence interval 3.25), Sensitivity and specificity of PMRP wer e adequate for diagnostic purposes; however, their values rely on the prior PMRP-AHI cut-off point selected with reference to full-PSG-AHI > 10. The clinical therapeutic decision taken after PMRP agreed with tha t taken with full-PSG in 79 patients (89%). Although 10% of the studie s with an individual set-up needed repetition, both of the domiciliary modalities (with and without a technician's intervention) were, econo mically, about three times more efficient than full-PSG. In conclusion , we believe that patients with a suspected sleep apnoea/hypopnoea syn drome should initially be studied in a home setting with a portable mo nitor of respiratory parameters, since it is a reliable method with an acceptable cost-effective profile.