Diagnosis, Cost and Therapeutic Decision-Making of Home Respiratory Polygraphy for Patients Without High Suspicion of OSA or With Comorbidity - Hospital Polysomnography in Comparison With Three Nights of Home Respiratory Polygraphy

Study subjects The study population consisted of subjects who were referred to the sleep unit of the Clínic Hospital, Barcelona, Spain, or the San Pedro de Alcantara Hospital, Cáceres, Spain, with a mild-moderate clinical suspicion of OSA or with notorious co-morbidity that induced frequent symptoms which mimicked those of OSA or could reduce sleep time.

The inclusion criteria were: a) Patients with snoring and/or some observed apneas during sleep. b) Epworth scale less than 15. c) Subjects with notorious co-morbidity. d) Age between 18 and 75 years.

The exclusion criteria were as follows: high suspicion of sleep apnea (heavy snoring, breathing pauses and somnolence that makes social life or working difficult, without any other causes of hypersomnia); diagnosis of OSA; severe heart disease or resistant systemic hypertension; suspicion of non-apneic sleep disorders, such as narcolepsy, REM behavior disorders, and restless leg syndrome; psychophysical disability that would impede the application of the home polygraphy device or major co-morbidity (unstable heart disease, unstable pulmonary disease or disabling stroke); and lack of informed consent for the protocol approved by the ethics committees of the two centres.

Protocol We compared 3N-HRP with laboratory-standard PSG in randomized patients who met the inclusion and exclusion criteria. The subjects were studied on a random basis for one night in a sleep lab (standard PSG) and for three consecutive nights with HRP. Once the first test had started, the second test was scheduled for within the following two days. PSG and HRP were scored separately and the technicians and physicians were blinded to any identifying information about the patients, as well as to any previous results.

Measurements Clinical data: Gender, age, weight, height, body mass index (BMI), waist-hip ratio, neck circumference, systolic and diastolic blood pressure, and alcohol intake measured as ≤ 60 gr/day or > 60 gr/day, and tobacco consumption.