Is there a cost-effective way to diagnose mild sleep-disordered breathing?

Question of the study:To determine the utility and the cost-effectiveness of oesophageal pressure, respiratory flow and movement, and oximetry (ORO) as a diagnostic tool for mild sleep-disordered breathing (SDB), as compared with overnight polysomnography (PSG). Patients and methods: Seventy-nine patients evaluated for mild SDB by PSG and simultaneously by oesophageal pressure (P,,) measurement, oximetry, respiratory flow and respiratory Movement on a single night. An oesophageal event (OF) was defined as irregular respiration with crescendo in Pes and rapid return to baseline with a minimal increase in the negative Pes at the end of the OF of at least 5 cm H2O or more than 50% of the baseline level. SDB was defined by ORO when oesophageal events were > 5/h, and by PSG when the respiratory disturbance index was > 5/h. The diagnostic accuracy and cost-effectiveness of ORO were compared with PSG. Results: Although the ability of ORO to detect SDB was poor: sensitivity 64%, specificity 78%, use of ORO for screening prior to PSG would have saved 5000 EUR per 100 patients compared to initial PSG. Conclusion: Using the combination of oesophageal pressure, respiratory I-low and movement and oximetry for the diagnosis of mild SDB is not cost-effective, because of its poor diagnostic accuracy New devices having alternative means to predict arousal and respiratory effort varaition should be evaluated for cost-effectiveness. (C) 2002 Published by Elsevier Science Ltd.