Abstract
Background
Obstructive sleep apnoea (OSA) is a significant public health problem with large health and economic burden. Despite the existence of effective treatment, undiagnosed OSA remains a challenge. The gold standard diagnostic tool is polysomnography (PSG), yet this test is expensive, labour intensive, and time-consuming. Home-based, limited channel sleep study testing (Level 3 and 4) can advance and widen access to diagnostic services. This systematic review aims to summarise available evidence regarding the cost-effectiveness of limited channel tests compared to laboratory and home PSG in diagnosing OSA.
Method
Eligible studies were identified across the following databases: MEDLINE, Psychinfo, Proquest, Scopus, CINAHL, Cochrane, Emcare and Web of Science. Studies were screened, critically appraised and eligible data were extracted using a standardised template. Relevant findings were summarised using a qualitative approach adhering to economic reporting standards.
Results
915 non-duplicate abstracts were identified, 82 full-text articles were retrieved for review. 32 studies met the inclusion criteria and were included in the final analysis: 28 studies investigated Level 3 and four assessed Level 4 OSA diagnostic tests. Using a dominance ranking framework to compare cost and outcomes, both Level 3 and Level 4 OSA diagnostic tests were cost-effective compared to PSG.
Discussion
Although study designs and methodologies differ broadly, findings indicate that using limited channel diagnostic sleep tests for OSA is associated with lower cost and non-inferior health outcomes relative to PSG. Limited channel tests also resulted in shorter waiting times and improvements in access to diagnostic services for patients with OSA.