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At least 19 recordsLinked to original sources
PubMed1997

Practice parameters for the indications for polysomnography and related procedures. Polysomnography Task Force, American Sleep Disorders Association Standards of Practice Committee.

These clinical guidelines, which have been reviewed and approved by the Board of Directors of the American Sleep Disorders Association, provide recommendations for the practice of sleep medicine in North America regarding the indications for polysomnography in the diagnosis of sleep disorders. Diagnostic categories that are considered include the following: sleep-related breathing disorders; neuromuscular disorders and sleep-related symptoms; chronic lung disease; narcolepsy; parasomnias; sleep-related epilepsy; restless legs syndrome; periodic limb movement disorder; depression with insomnia; and circadian rhythm sleep disorders. Whenever possible, conclusions are based on evidence from review of the literature. Where scientific data are absent, insufficient, or inconclusive, recommendations are based on consensus of opinion. The Standards of Practice Committee of the American Sleep Disorders Association appointed a task force to review the topic, the indications for polysomnography and related procedures. Based on the review and on consultation with specialists, the subsequent recommendations were developed by the Standards of Practice Committee and approved by the Board of Directors of the American Sleep Disorders Association. Polysomnography is routinely indicated for the diagnosis of sleep-related breathing disorders; for continuous positive airway pressure (CPAP) titration in patients with sleep-related breathing disorders; for documenting the presence of obstructive sleep apnea in patients prior to laser-assisted uvulopalatopharyngoplasty; for the assessment of treatment results in some cases; with a multiple sleep latency test in the evaluation of suspected narcolepsy; in evaluating sleep-related behaviors that are violent or otherwise potentially injurious to the patient or others; and in certain atypical or unusual parasomnias. Polysomnography may be indicated in patients with neuromuscular disorders and sleep-related symptoms; to assist in with the diagnosis of paroxysmal arousals or other sleep disruptions thought to be seizure-related; in a presumed parasomnia or sleep-related epilepsy that does not respond to conventional therapy; or when there is a strong clinical suspicion of periodic limb movement disorder. Polysomnography is not routinely indicated to diagnose chronic lung disease; in cases of typical, uncomplicated, and noninjurious parasomnias when the diagnosis is clearly delineated; for patients with epilepsy who have no specific complaints consistent with a sleep disorder; to diagnose or treat restless legs syndrome; for the diagnosis of circadian rhythm sleep disorders; or to establish a diagnosis of depression.

Circadian Rhythm↗
PubMedDate not supplied

[Comparative analysis of the clinical history and polysomnography in sleep disorders. Diagnostic relevance of polysomnography].

INTRODUCTION: The incidence of associate pathologies has been studied during the sleep, as well as the diagnostic efficiency of the clinical history. PATIENTS AND METHODS: Patients (n = 136) remitted by diverse services, have been studied. It has been carried out a complete polysomnography, as well as other supplementary studies (anxiety and depression tests, excessive daytime sleepiness Epworth's test, EEG and sleep notebook). RESULTS: The most common symptom turned out to be the primary snores, followed by the excessive daytime sleepiness and apneas. The results of the excessive daytime sleepiness Epworth's test and the anxiety and depression tests were not useful to differ among pathologies, not even between pathologies and patients with normal sleep. The percentage of diagnosis of suspicion confirmed by the polysomnography was of 39.7%, while in 11% of the total of patients it was observed the existence of more than a pathology of the sleep. In 49.3% of the cases the polysomnographic diagnosis was completely different from the diagnosis of suspicion. Among the patients with clinic suspicion of apnoea, in 48.3% of the cases the existence of the same one was verified, although in 14.6% it was associated with other pathologies. In 51.7% of the patients it was not possible to confirm this pathology. CONCLUSIONS: The clinical history is not enough for the diagnosis of the pathologies of the sleep. On the other hand, the existence of associate pathologies diminishes the value of several 'screening-methods'. Therefore, it is fundamental to carry out a complete polysomnography in all the patients that present any sleep disorder on the part of doctors that approach the problem of the sleep in a global way and not only thinking in the possible existence of syndrome of sleep apnoea.

Adolescent↗
PubMed1996

Diagnostic use of daytime polysomnography versus nocturnal polysomnography in sleep apnea syndrome.

The usefulness of daytime polysomnography (DPSG) in the diagnosis of sleep apnea syndrome (SAS) is examined. Diagnostic use was investigated by conducting DPSG of two different time periods (Group M, 11.00-14.00 h, and Group A, 15.00-18.00 h). The subjects were 30 patients (28 men and two women; mean age, 54.0 years). Nocturnal polysomnography (NPSG) and DPSG were investigated by comparing indices of sleep, apnea index (AI) and arterial oxygen saturation (SaO2). There was no significant difference among these indices but there was a significant positive correlation between NPSG and DPSG in all variables related to sleep apnea. Moreover, there was no significant difference in the frequency of each type of apnea between NPSG and DPSG in either group. These findings suggest that DPSG is useful not only in diagnosing SAS but in evaluating its severity.

Adult↗
PubMed1993

[Diurnal sleep study for sleep related breathing disorders--comparative study of diurnal polysomnography using diazepam with nocturnal polysomnography].

UNLABELLED: Nocturnal polysomnography (n-PSG) and diurnal polysomnography using diazepam (d-PSGD) were performed on 46 patients with sleep related breathing disorders including sleep spnea syndrome (SAS) patients and simple snorers. Sleep stage, apnea type, and various indices of breathing disorders were examined, and the results obtained by the two different sleep studies were compared. There were no significant differences in either the apnea type or the indices of breathing disorders between the two sleep studies. Concerning the sleep stage, significant differences in the duration of REM sleep between the two sleep studies were observed. In the duration of each stage of NREM sleep, however, there were no significant differences. Also, no significant differences were observed in the indices of breathing disorders between SAS patients and simple snorers. IN CONCLUSION: d-PSGD can be utilized as a substitute for n-PSG clinically, in patients with sleep related breathing disorders, as far as the study of NREM stages is concerned.

Adolescent↗
PubMed1992

Comparison of nap and overnight polysomnography in children.

Overnight polysomnography is the "gold standard" for diagnosing sleep-disordered breathing. However, the limited number of resources for pediatric polysomnography make the availability of a screening test for sleep-disordered breathing highly desirable. Therefore, we compared 1 hour daytime nap polysomnography to overnight polysomnography in 40 children [mean age, 5.4 +/- 0.8 (SE) years] with sleep-disordered breathing; 76% of children were sedated with chloral hydrate for nap polysomnography; none was sedated for overnight polysomnography. Studies were done 26 +/- 4 days apart. Chest wall motion, ECG, end-tidal PCO2 (PETCO2), arterial oxygen saturation (SaO2), and electrooculogram were monitored. Nap studies had a sensitivity of 74%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 17% in predicting sleep-disordered breathing. Significantly more children had obstructive apnea and desaturation (SaO2 less than 90%) during overnight polysomnography. The peak PETCO2 and the SaO2 nadir were significantly worse during overnight polysomnography. However, the percentage of time during which abnormalities were manifested did not differ between nap and overnight polysomnography. Despite the use of sedation, nap polysomnography underestimated sleep-disordered breathing. We conclude that sleep-disordered breathing detected by nap polysomnography is always confirmed by overnight polysomnography and speculate that nap polysomnography may be an effective screening method for sleep-disordered breathing. However, overnight polysomnography should be performed if nap polysomnography is inconclusive. Chloral hydrate may be used effectively to facilitate sleep for nap polysomnography in children.

Adolescent↗
PubMed2004

Evaluation of the accuracy of SNAP technology sleep sonography in detecting obstructive sleep apnea in adults compared to standard polysomnography.

OBJECTIVE: To determine the accuracy of snoring and apnea analysis by SNAP (SNAP Laboratories; Glenview, IL), a technology that uses snoring recorded by a home microphone system and nasal airflow, to diagnose obstructive sleep apnea (OSA) as well as determine its severity. METHODS: For all patients who had undergone a prior SNAP study and were referred to the Sleep Disorders Center of Lifespan Hospitals for polysomnography testing from January 2000 through December 2001, we compared the results of the SNAP study to standard polysomnography (polysomnography). The severity of each apnea-hypopnea index (AHI) [mild, moderate, or severe, as defined by the AHI Severity Task Force of the American Academy of Sleep Medicine] recorded by SNAP was compared to that of the polysomnography result. All polysomnography tests were scored independently and without the prior knowledge of any SNAP results. RESULTS: For the 31 patients on whom data were available, the mean age, body mass index, and Epworth sleepiness scale scores were 50.3 years (range, 29 to 77 years), 31.6 kg/m(2) (range, 24 to 44 kg/m(2)), and 11.3 (range, 1 to 20), respectively. The mean follow-up time between the two studies was 5 months. The severity criteria indicated by the SNAP study accurately assessed the true severity confirmed by polysomnography in only 11 of 31 patients (35.5%). When the AHI severity score from the SNAP study was compared to polysomnography using a kappa statistic measure of agreement, there was overall agreement with a kappa value of 0.23 (p = 0.008), but the agreement was only fair. SNAP study severity scores were overestimated in 13 of 31 patients (41.9%) compared to the polysomnography results. In the majority of these subjects (8 of the 13 "overestimated" patients or 8 of 31 total patients [25.8%]), the SNAP study diagnosed OSA when the patient had a normal polysomnography finding. CONCLUSION: Although there may be some night-to-night variability in polysomnography testing, these results suggest that SNAP studies do not appear to accurately assess the severity of OSA.

Adult↗
PubMed2006

Toddler behavior following polysomnography: effects of unintended sleep disturbance.

STUDY OBJECTIVES: Childhood sleep disorders are consistently shown to affect behavior and cognition, but first-night effects on these measures are generally unknown. We sought to examine how sleep in the home versus the laboratory differed among healthy toddlers and how such differences relate to standardized scores on assessments the morning following polysomnography. DESIGN, SETTING, AND PARTICIPANTS: Twenty healthy 14-month-olds wore actigraphs during nighttime sleep at home for 5 nights preceding and during standard overnight laboratory polysomnography. The Bayley Scales of Infant Development (BSID-II) were administered once the morning after polysomnography. MEASUREMENTS AND RESULTS: All subjects had normal polysomnography. Sleep-start times at home and during polysomnography did not differ, whereas, during polysomnography, subjects awoke earlier (p = .008, d = .58), their total sleep time (p <. 001, d = 1.1) and sleep efficiency (p = .004, d = .57) were reduced, and they had shorter sleep-bout lengths (p = .004, d = .03), less immobility (p = .003, d = .62), and greater average activity during sleep (p <. 001, d = .98). Standardized assessments were not affected by differences between home and polysomnography night sleep, but children with greater emotional regulation difficulty had a lower percentage of immobility (r = -0.67, p = .001) and increased sleep fragmentation (r = -0.60, p = .005) during polysomnography. CONCLUSIONS: Although sleep-onset times were preserved, sleep in the laboratory was disrupted, compared with at home. These differences did not affect standardized scores, but the magnitude of the difference was associated with worse emotional regulation. The effects of sleep disturbance during polysomnography, or the influence of poor emotional regulation on sleep in the laboratory, should be considered in studies of young children.

Attention Deficit Disorder with Hyperactivity↗
PubMed1994

Clinical diagnosis of pediatric obstructive sleep apnea validated by polysomnography.

The decision to perform tonsillectomy and adenoidectomy for treatment of pediatric obstructive sleep apnea syndrome is often made on a clinical basis without formal polysomnography. To examine the accuracy of the clinical diagnosis of pediatric obstructive sleep apnea syndrome, we prospectively evaluated 30 children with obstructive symptoms by a standardized history, physical examination, and review of a tape recording of breathing during sleep. On the basis of this clinical evaluation, patients were divided into three predictive groups: (1) definite obstructive sleep apnea syndrome, (2) possible obstructive sleep apnea syndrome, and (3) unlikely to have obstructive sleep apnea syndrome. Nocturnal polysomnography was used to determine the presence or absence of true sleep apnea. Ten of 18 (55.6%) patients predicted clinically to have definite obstructive sleep apnea syndrome had positive nocturnal polysomnographies. Two of six (33.3%) patients predicted to have possible obstructive sleep apnea syndrome had positive nocturnal polysomnographies. One of six (16.7%) patients predicted to be unlikely to have obstructive sleep apnea syndrome had a positive nocturnal polysomnography. Six nocturnal polysomnographies negative by conventional criteria were suspicious for apnea, but considering these positive for obstructive sleep apnea syndrome did not improve the specificity of the clinical prediction. Our results show that clinical assessment of obstructive sleep apnea syndrome in children is sensitive (92.3%) but not specific (29.4%) for making the diagnosis of obstructive sleep apnea syndrome as compared with nocturnal polysomnography and may contribute to the decision to obtain nocturnal polysomnography in specific circumstances.

Adolescent↗
PubMed1985

Utilization of polysomnography in the assessment of sleep disorders.

Polysomnography is an indispensable tool in dealing with sleep disorders, but because of its inherent logistical complexity and expense, it must be used with discretion. Many sleep disorders can be diagnosed clinically by the astute physician and treated empirically with good results. On the other hand, there are numerous circumstances in which the best clinical judgment indicates a polysomnographic evaluation. The ubiquity of sleep complaints in medical practice, and the knowledge that they may in some instances be associated with life-threatening medical complications, compel the modern clinician to obtain a basic knowledge of the appropriate utilization of the sleep laboratory. Polysomnography is a useful adjunct to the clinician because it provides objective information to be integrated into the overall clinical picture in the evaluation of the patient's complaint. Polysomnography should be utilized in cases where the results will clearly make a difference in the differential diagnosis or in the treatment plan. If a clinician's basic approach to the evaluation of the patient or his treatment will not be substantially altered by polysomnography, it should not be undertaken. The results of polysomnography should give the referring physician critical information concerning the type of disorder, its severity, appropriate treatment and necessary follow-up. Unfortunately, few, if any, hard and fast rules exist concerning the appropriate utilization of polysomnography. As always in medicine, the physician must take a careful history, and integrate it with other basic laboratory tests and the physical examination, and then decide whether polysomnography will provide useful additional information. The ability to assess physiological phenomena during sleep objectively has clearly advanced the study of sleep disorders to the point that it is now considered an integral part of internal medicine. Polysomnography has made available the objective study and documentation of sleep disorders which, coupled with increasing sophistication concerning the natural history of sleep disorders, have created a new and exciting discipline in clinical medicine.

Cost Control↗
PubMed1995

Practice parameters for the use of polysomnography in the evaluation of insomnia. Standards of Practice Committee of the American Sleep Disorders Association.

These clinical guidelines, which have been reviewed and approved by the Board of Directors of the American Sleep Disorders Association, provide recommendations for the practice of sleep medicine in North America for the use of polysomnography in the evaluation of insomnia. The diagnosis of sleeplessness, or insomnia, is primarily based upon a careful, detailed medical and psychiatric history. Clinicians have sought an objective means to measure this symptom and have, therefore, turned to polysomnography. The American Sleep Disorders Association has assessed the available data and produced guidelines for the use of polysomnography in evaluating the symptoms of insomnia. Polysomnography is not required for the routine evaluation of transient or chronic insomnia. Polysomnography is, however, indicated in the evaluation of suspected sleep-related breathing disorders and periodic limb movement disorder, which may occasionally contribute to a complaint of insomnia, particularly in middle-aged or elderly patients. In addition, when the cause of insomnia is uncertain or when behavioral or pharmacologic therapy is unsuccessful, polysomnography may be helpful.

Guidelines as Topic↗
PubMed1991

Polysomnography at a sleep disorders unit in Melbourne.

OBJECTIVE: To outline the procedure of polysomnography as carried out in a sleep disorders unit in Melbourne and to describe the patients undergoing polysomnography in terms of their age and sex and the sleep disorder diagnosed. DESIGN: A retrospective survey of consecutive patients who required diagnostic polysomnography. SETTING: The Sleep Disorders Unit at Epworth Hospital, a large private hospital in Melbourne. PATIENTS: Two hundred consecutive patients who underwent polysomnography over a seven-month period. Their ages ranged from 19 to 77 years. INTERVENTIONS: All patients had diagnostic polysomnography for one night in the sleep laboratory. This involved 12 to 14 physiological variables being monitored continuously overnight by means of a new digital recording and sleep analysis system. MAIN OUTCOME MEASURES: Patients were categorised according to their main sleep disorder or primary diagnosis. Additional sleep disorders in some patients were categorised as secondary diagnoses. RESULTS: The commonest age group among both male and female patients was 40-49 years. Overall, men outnumbered women three to one. Almost two-thirds of all patients had as their primary diagnosis some degree of obstructive sleep apnoea syndrome or simple snoring. The next most common diagnosis was periodic limb movement disorder. The remaining diagnoses included a variety of sleep disorders, from narcolepsy to sleep terrors. CONCLUSIONS: Despite its complexity and time-consuming nature, polysomnography is an essential procedure for the diagnosis and treatment of a wide range of sleep disorders. More sleep laboratories and a greater emphasis on the multidisciplinary teaching of sleep disorders medicine will be required in Australia.

Adult↗
PubMed2001

Sleep polysomnography as a predictor of recurrence in children and adolescents with major depressive disorder.

Adults with major depressive disorder (MDD) demonstrate certain sleep polysomnographic abnormalities, including sleep continuity disturbances, reduced slow-wave sleep, shortened rapid eye movement (REM) latency, and increased REM density. Findings of sleep EEG studies in depressed children and adolescents have yielded conflicting results, possibly because of methodological variations across the studies. Generally, however, studies have demonstrated that depressed children and adolescents exhibit less sleep continuity and non-REM sleep differences in comparison with control subjects than do adults. Thus, results from adult sleep polysomnography studies cannot necessarily be generalized to children and adolescents. Depressed adults who have reduced REM latency during the symptomatic episode appear more likely to have a relapse once treatment is discontinued than those with normal REM latency. No studies of the relationship between sleep polysomnographic variables and clinical course have been reported in depressed children and adolescents. Data for baseline clinical variables and 3 nights of sleep polysomnography were examined in 113 depressed children (< or = 12 yr; n = 51) and adolescents (> or = 13 yr; n = 62) (56 in-patients and 57 outpatients) where data was available on at least 1 yr of naturalistic follow-up. Subjects came from 2 studies of sleep polysomnography in children and adolescents with MDD. Clinical course was assessed using the Kiddie-Longitudinal Interval Follow-Up Evaluation (K-LIFE). This interview was used to define recovery from the index episode of MDD and recurrence, a new episode of meeting full criteria for MDD. Clinically, within 1 yr of initial evaluation 102/113 subjects had recovered from their index episode of depression (minimal or no symptoms for 60 d). Of the 102 subjects who recovered, 36 (35.3%) had a recurrence of MDD. The majority of subjects (55%) who had a recurrence were not on medication at the time of recurrence. Subjects who had a recurrence were more likely to report suicidal thoughts or attempts at baseline compared to those without a recurrence (67 vs. 37%; F = 8.77; p = 0.004). On baseline sleep polysomnography, subjects with a later recurrence had decreased sleep efficiency and delayed sleep onset (sleep latency > 10 min). Probability of recurrence at 12 months was 0.39 compared to 0.15 in subjects with non-delayed sleep onset (p = 0.005). Baseline suicidal ideation and sleep dysregulation on sleep polysomnography predicted recurrence in a large sample of depressed children and adolescents. Depression in children and adolescents is frequently a chronic, recurrent illness. Factors that can predict clinical course are important in increasing our understanding of depression in this age group.

Adolescent↗
PubMed2000

Multiple sleep latency test and polysomnography in diagnosing Kleine-Levin syndrome and periodic hypersomnia.

Kleine-Levin syndrome and periodic hypersomnia are often misdiagnosed initially because there is no objective test for these conditions. To determine the value of the Multiple Sleep Latency Test and polysomnography in this respect, the authors studied four patients with Kleine-Levin syndrome or periodic hypersomnia who had taken the Multiple Sleep Latency Test and undergone polysomnography during the symptomatic episode and/or during the asymptomatic interval. During but not between symptomatic episodes, the Multiple Sleep Latency Test revealed abnormal sleep latencies in all patients, and polysomnography revealed increased rapid eye movement propensity in one patient and a reduction in delta-sleep in two patients. In conclusion, the Multiple Sleep Latency Test and polysomnography are useful in diagnosing Kleine-Levin syndrome and periodic hypersomnia, especially when administered in a standardized fashion during and after the symptomatic period. The authors recommend that polysomnography and the Multiple Sleep Latency Test be performed no earlier than the second night after the onset of a symptomatic episode and the following day to reveal maximal hypersomnolence, and more than 2 weeks after a symptomatic episode to represent the asymptomatic interval.

Adolescent↗
PubMed1993

Bedside polysomnography as an adjunct in the management of infants with Robin sequence.

Objective indications for tongue-lip adhesion in infants with Robin sequence have been lacking because of the difficulty in assessing the clinical significance of airway obstruction. In 1988, we began to use 20-hour, four-channel polysomnography to assist us in the management of infants with Robin sequence. The four channels included electrocardiogram, respiratory motion, airflow, and oxygen saturation. Infants demonstrating significant episodes of airway obstruction during sleep were recommended for tongue-lip adhesion. Fifteen infants with Robin sequence were evaluated during a 3-year period. Two babies were having severe, clinically obvious events on admission and underwent tongue-lip adhesion without polysomnography. Polysomnography was done on the other 13 infants. No significant events were seen in 7 infants, and they were discharged after a mean hospitalization of 8 days. Six studies documented significant airway obstruction, and tongue-lip adhesion was recommended. Follow-up polysomnography performed after successful tongue-lip adhesion failed to show any significant events, and the infants only required hospitalization for a mean of 12 days. We conclude that polysomnography is a useful adjunct in the management of infants with Robin sequence, providing objective indications for surgical intervention and shortening hospitalization.

Humans↗
PubMed1995

Accuracy of an intelligent CPAP machine with in-built diagnostic abilities in detecting apnoeas: a comparison with polysomnography.

BACKGROUND: In patients with sleep apnoea early diagnostic evaluation and treatment may be delayed due to limited access to full polysomnography (PSG). For "typical" patients, simplified strategies are needed. A study was performed to evaluate the accuracy of a new continuous positive airway pressure (CPAP) device with in-built diagnostic abilities (Autoset) in detecting apnoeas. METHODS: Twenty seven patients underwent full overnight polysomnography. Data with the Autoset were acquired simultaneously. Standard nasal prongs were used. Apnoeas were detected by special analysis of the flow signal. As the Autoset derives all its data from one signal, careful examination of the raw data is important to assess the quality of the flow signal. RESULTS: There was a correlation between the apnoea index (AI) assessed by the Autoset (AI-Autoset) and by polysomnography AI-PSG (r = 0.85) and between the AI-Autoset and the apnoea/hypopnoea index (AHI) during polysomnography (r = 0.87). The Autoset identified patients with an AHI-PSG of > 20 (a level of respiratory disturbance that would warrant consideration for treatment in most centres for sleep disorders) with a sensitivity of 82% and a specificity of 90%. CONCLUSIONS: The good correlation between the apnoea index measured by the Autoset and by polysomnography, and the high sensitivity in detecting patients with an AHI of > 20, may make the Autoset a valuable tool for the management of typical patients with sleep apnoea. However, very low values for nasal ventilation on the printout raises the suspicion of poor signal quality and misleading results.

Adult↗
PubMed1999

Cost-utility of three approaches to the diagnosis of sleep apnea: polysomnography, home testing, and empirical therapy.

BACKGROUND: Obstructive sleep apnea syndrome (OSAS) is usually diagnosed with overnight polysomnography in a sleep laboratory. Home sleep studies can be performed at lower cost, but results are somewhat less reliable. Bedside diagnosis of OSAS without any testing has also been discussed. OBJECTIVE: To model the costs and utility of laboratory polysomnography, home study, and no testing during the 5 years after initial evaluation for OSAS. DESIGN: Cost-utility analysis. DATA SOURCES: Published data. TARGET POPULATION: Hypothetical cohort of persons suspected of having OSAS. TIME HORIZON: The 5 years after initial evaluation for OSAS. PERSPECTIVE: Societal. INTERVENTION: Nasal continuous positive airway pressure when OSAS was diagnosed. MEASUREMENTS: Quality of life, survival and charges (as proxies for costs) for each diagnostic method. RESULTS OF BASE-CASE ANALYSIS: Under almost all modeled conditions, polysomnography provided maximal quality-adjusted life-years in the 5 years after the initial diagnostic evaluation. The incremental charges for polysomnography over home study or no testing were about $13,400 and $9200, respectively, per quality-adjusted life-year gained during this period. RESULTS OF SENSITIVITY ANALYSIS: Results were sensitive to the utility of treatment in the absence of OSAS. CONCLUSIONS: The cost-utility of polysomnography instead of home study or no testing in the diagnosis of OSAS compares favorably with that of other procedures for which society judges the added utility per dollar spent to be worthwhile. More precise determination of certain key variables in this model should be a goal of future research.

Cost-Benefit Analysis↗