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Artículos socios - Artículos
Efficacy of Home Single-Channel Nasal Pressure for recommending CPAP treatment in Sleep Apnea.An expert system for non-experts
12/05/2016
Juan F Masa MD,PhD1,17(*), Joaquin Duran-Cantolla MD,PhD2,13,17(*), Francisco Capote MD,PhD3, Marta Cabello MD4, Jorge Abad MD5,17, Francisco Garcia-Rio MD6,17, Antoni Ferrer MD, PhD7,17, Ana M Fortuna8,17, Nicolas Gonzalez-Mangado MD,PhD9,17, Monica de la Peña MD10,17, Felipe Aizpuru2, Ferran Barbe MD,PhD11,17 and Jose M Montserrat MD,PhD12,17 on behalf of the Spanish Sleep Network:  Luis D Larrateguy MD15, Jorge Rey de Castro MsC16, Estefania Garcia-Ledesma MD1,17, Jaime Corral MD1,17, Maria J Martin-Vicente MD1,17, Cristina Martinez-Null MD2,14,17, Carlos Egea MD2,14,17, Laura Cancelo MD2,14, Emilio García-Díaz MD,PhD3, Carmen Carmona-Bernal MD,PhD3, Ángeles Sánchez-Armengol MD,PhD3, Merche Mayos MD8,17,Rosa M Miralda8,17, Maria F Troncoso MD9, Monica  Gonzalez MD4, Marian Martinez-Martinez MD4, Olga Cantalejo4, Javier Piérola MD,PhD10,17, Laura Vigil, MD,PhD7, Cristina Embid MD12, Mireia del Mar Centelles MD12, Teresa Ramírez Prieto, MD18, Blas Rojo, MD18 and Vanesa Lores, MD19.
Sleep. 2015;38:13-21

INTRODUCTION: Unlike other prevalent diseases, obstructive sleep apnea (OSA) has no simple tool for diagnosis and therapeutic decision-making in primary healthcare. Home single-channel nasal pressure (HNP) may be an alternative to polysomnography for diagnosis but its use in therapeutic decisions has yet to be explored.

OBJECTIVES: To ascertain whether an automatically scored HNP apnea-hypopnea index (AHI), used alone to recommend continuous positive airway pressure (CPAP) treatment, agrees with decisions made by a specialist using polysomnography and several clinical variables.

METHODS: Patients referred by primary care physicians for OSA suspicion underwent randomized polysomnography and HNP. We analyzed the total sample and both more and less symptomatic subgroups for Bland and Altman plots to explore AHI agreement; receiver operating characteristic curves to establish area under the curve (AUC) measurements for CPAP recommendation; and therapeutic decision efficacy for several HNP AHI cutoff points.

RESULTS: Of the 787 randomized patients, 35 (4%) were lost, 378 (48%) formed the more symptomatic and 374 (48%) the less symptomatic subgroups. AHI bias and agreement limits were 5.8 ± 39.6 for the total sample, 5.3 ± 38.7 for the more symptomatic, and 6 ± 40.2 for the less symptomatic subgroups. The AUC were 0.826 for the total sample, 0.903 for the more symptomatic, and 0.772 for the less symptomatic subgroups. In the more symptomatic subgroup, 70% of patients could be correctly treated with CPAP.

CONCLUSION: Automatic HNP scoring can correctly recommend CPAP treatment in most of more symptomatic patients with OSA suspicion. Our results suggest that this device may be an interesting tool in initial OSA management for primary care physicians, although future studies in a primary care setting are necessary.


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