Abstract
Purpose
The capacity for performing sleep study is limited. We made a simulation to study whether a diagnosis of obstructive sleep apnoea syndrome (OSAS) and prescription of nasal continuous positive airway pressure (CPAP) therapy would be possible and cost-effective without performing a sleep study.
Methods and objectives
One hundred ninety-seven consecutive patients referred to a pulmonary clinic due to suspected OSAS were included. Professional drivers, patients with neurological diseases, heart failure or aged <25 years were excluded. Two experts evaluated patient records retrospectively in a stepwise manner. In step 1, they were blinded to the sleep study results, and in step 2, the results were available.
Results
Mean age was 51.5 ± 10.8 years, BMI 31.9 ± 7.2 kg/m2, apnoea–hypopnoea index 19.8 ± 20.7/h and Epworth Sleepiness Scale 8.3 ± 4.7. Without sleep study results, the experts would initiate CPAP in 52.5% of patients (step 1), equalling to 74.7% of those whom they would suggest it after reviewing the sleep studies (step 2). In step 2, they suggested CPAP for 70.3% of all patients, while the clinicians responsible for the treatment for 66%. Net savings equal to the costs of CPAP device with interface for 50–100% of patients in need of this therapy depending on whether calculations are based on the costs of cardiorespiratory polygraphy or polysomnography.
Conclusions
Nasal CPAP therapy would be possible to initiate without a sleep study for the majority of patients with suspected OSAS resulting in significant cost reduction.
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Acknowledgements
Sirkka Hakko, practical nurse; Satu Hemling, RN; Sari Melkko-Partanen, RN and Maija Nevä, practical nurse, are acknowledged for gathering and blinding of the data. Hans Helenius, MSc, is acknowledged for statistical advice.
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The authors declare that they have no conflict of interest.
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Anttalainen, U., Liippo, K. & Saaresranta, T. Diagnosis and initiation of nasal continuous positive airway pressure therapy for OSAS without a preceding sleep study?. Sleep Breath 15, 791–797 (2011). https://doi.org/10.1007/s11325-010-0440-6
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DOI: https://doi.org/10.1007/s11325-010-0440-6