A quagmire for clinicians: when technological advances exceed clinical knowledge
- Department of Pediatrics, Medicine, and Epidemiology
- Case Western Reserve University
- Rainbow Babies and Children’s Hospital
- 11100 Euclid Avenue
- Cleveland
- Ohio 44106-6003
- USA
- Department of Medicine and Anesthesiology
- University of Pittsburgh School of Medicine
- Veterans Affairs Medical Center
- and Pulmonary Sleep Disorders Program
- University of Pittsburgh Medical Center
- Pittsburgh
- Pennsylvania
- USA
Obstructive sleep apnoea hypopnoea syndrome (SAHS) is currently estimated to affect between 2% and 25% of the adult population.1 2 Increasingly, data indicate that obstructive SAHS, if untreated, may result in both short and long term sequelae including daytime sleepiness, poor quality of life, neuropsychological impairment, hypertension, and cardio-cerebrovascular diseases.3 Its high prevalence and potentially substantial morbidity present challenges to the health care system and to individual care providers to diagnose and identify those individuals at greatest risk of obstructive SAHS related complications and those most likely to benefit from specific interventions. On the one hand, the costs associated with evaluation with the “gold standard” (overnight laboratory based multichannel polysomnography) could exceed $1500/patient. In the USA this cost alone could result in annual health care expenditures of >$18 billion if all adults with suspected SAHS were tested.4 On the other hand, the economic costs of untreated SAHS are substantial. These, however, are more difficult to estimate since they may include the costs associated with loss of work productivity, occupational and vehicular accidents, and potentially preventable hypertension and cardio-cerebrovascular diseases. Regarding the latter alone, it has been estimated that between $3 million and $2 billion spent on treatment of hypertension and cardiovascular diseases annually in the USA may be reduced by effective treatment of SAHS (estimates varying according to the estimated attributable risk).4 In times of escalating aggregate health care costs, how should the appropriate balance between costs and benefits be achieved?
One strategy to reduce the costs associated with using complex expensive technology to diagnose a condition associated with common symptoms (snoring and daytime sleepiness, found in >50% to >20% of the population, respectively3) is to use screening tests and/or diagnostic tests that are simpler and less costly than overnight laboratory based polysomnography. When using …
