Cost-effectiveness analysis of nocturnal oximetry as a method of screening for sleep apnea-hypopnea syndrome

Chest
L J Epstein, G R Dorlac

Abstract

Determine the utility of nocturnal oximetry as a screening tool for sleep apnea-hypopnea syndrome (SAHS) compared with polysomnography (PSG). Cost-effectiveness analysis based on retrospective review of overnight sleep studies. United States Air Force tertiary teaching hospital. One hundred consecutive patients evaluated for SAHS by overnight sleep study. Participants underwent PSG and oximetry on the same night. Patients with obstructive sleep apnea had a continuous positive airway pressure trial. Oximetry was abnormal when > or =10 events per hour occurred. Two criteria were evaluated. A "deep" pattern of > 4% change in oxyhemoglobin saturation to < or =90%, and a "fluctuating" pattern of repetitive short-duration fluctuations in saturation. The diagnostic accuracy of both methods was compared with PSG. Cost-effectiveness of screening oximetry was compared with PSG alone and use of split-night studies. The fluctuating pattern had a greater sensitivity and negative predictive value, while the deep pattern had a greater specificity and positive predictive value. Oximetry screening using the fluctuating pattern was not as sensitive as PSG for detecting patients with mild disease; 17 of 28 patients (61%) with normal oximetry resu...Continue Reading

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