Diagnosis and initiation of nasal continuous positive airway pressure therapy for OSAS without a preceding sleep study?

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. 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. Mean age was 51.5 +/- 10.8 years, BMI 31.9 +/- 7.2 kg/m(2), 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. 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.