• Juan F Masa, Jaime Corral, Ricardo Pereira, Joaquin Duran-Cantolla, Marta Cabello, Luis Hernández-Blasco, Carmen Monasterio, Alberto Alonso, Eusebi Chiner, Jose Zamorano, Felipe Aizpuru, Jose M Montserrat, and Spanish Sleep Network.
• San Pedro de Alcántara Hospital, Cáceres, Spain. fmasa@separ.es
• Am. J. Respir. Crit. Care Med.. 2011 Oct 15;184(8):964-71.

RationaleHome respiratory polygraphy (HRP) is an alternative to polysomnography (PSG) for sleep apnea-hypopnea syndrome (SAHS) diagnosis. However, therapeutic decision-making is a different process than diagnosis.ObjectivesThis study aimed to determine the agreement between HRP and in-hospital PSG for therapeutic decision-making in a large sample.MethodsPatients with an intermediate or high SAHS suspicion were included in a multicenter study (eight sleep centers) and assigned to home and hospital protocols in a random order. Therapeutic decisions (continuous positive airway pressure, no continuous positive airway pressure, or impossible decision) were made by an investigator in each center, based on using either HRP or PSG and a single set of auxiliary clinical variables. Patients and diagnostic methods (HRP and PSG) were assessed in random order using an electronic database. After a month the same therapeutic decision-making procedure was repeated with the same method.Measurements And Main ResultsOf 366 randomized patients, 348 completed the protocol. The "impossible decision" case was not observed with either PSG or HRP. Therapeutic decisions using HRP had a sensitivity of 73%, a specificity of 77%, and an agreement level (sum of true positives and negatives) of 76%. Patients with higher HRP apnea-hypopnea index (AHI) scores (≥ 30; 41% of the total sample) had a sensitivity of 94%, a specificity of 44%, and the agreement level was 91%.ConclusionsThe HRP-based therapeutic decision was adequate when AHI was high, but deficient in the large population of patients with mild to moderate AHI. Therefore, both selecting patients with a high suspicion and severity of SAHS and future prospective cost-effectiveness studies are necessary.

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