Feasibility, Validity and Economic Impact of a Home-Based Sleep Screening Test in the Detection of Sleep-Related Breathing Disorders in Individuals Living With Spinal Cord Injury: A Multi-Method Study and Cost-Minimisation Analysis.

This prospective multi-method study was performed to assess the feasibility and validity of an unattended home-based sleep screening test (HBSST) in the detection of sleep-related breathing disorders (SRBDs) among individuals with spinal cord injury (SCI). Further, the economic impact of the HBSST was compared with polysomnography using cost-minimisation analysis. Adults with subacute/chronic (> 1 month) SCI were recruited for the multi-method study. Feasibility analysis included quantitative and qualitative data. A pilot validity analysis compared the apnea-hypopnea index (AHI) from the HBSST and from polysomnography in nine individuals with mild-to-severe SRBD. Notably, HBSST and polysomnography tests were separately performed. Of the 28 participants (11 females, 17 males; mean age: 54.9 years) with subacute/chronic, complete (n = 7) or incomplete SCI at cervical (n = 18), thoracic (n = 8) or lumbosacral levels, nine individuals were diagnosed with a moderate-to-severe SRBD. All participants successfully completed the HBSST. Most of the participants (60.71%) set up the device for the HBSST without any assistance. The AHI from the HBSST was significantly correlated with the AHI from the polysomnography (r = 0.717; p = 0.0248; n = 9). Finally, our results indicated that the use of HBSST was a cost-saving approach when compared with polysomnography. In conclusion, the results of our prospective multi-method study provided novel and clinically important data to support the feasibility and suggest criterion validity of a HBSST when compared with the findings from polysomnography completed during different nights. The results of our cost-minimisation analysis indicated that the HBSST is a more cost-effective strategy for detection of SRBDs in the SCI population than polysomnography.