Chest
Volume 138, Issue 2, August 2010, Pages 257-263
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Original Research
Sleep Medicine
Outcomes of Home-Based Diagnosis and Treatment of Obstructive Sleep Apnea

https://doi.org/10.1378/chest.09-0577Get rights and content

Background

Home diagnosis and therapy for obstructive sleep apnea (OSA) may improve access to testing and continuous positive airway pressure (CPAP) treatment. We compared subjective sleepiness, sleep quality, quality of life, BP, and CPAP adherence after 4 weeks of CPAP therapy in subjects in whom OSA was diagnosed and treated at home and in those evaluated in the sleep laboratory.

Methods

A randomized trial was performed consisting of home-based level 3 testing followed by 1 week of auto-CPAP and fixed-pressure CPAP based on the 95% pressure derived from the auto-CPAP device, and in-laboratory polysomnography (PSG) (using mostly split-night protocol) with CPAP titration; 102 subjects were randomized (age, 47.4 ± 11.4 years; 63 men; BMI, 32.3 ± 6.3 kg/m2; Epworth Sleepiness Scale [ESS]: 12.5 ± 4.3). The outcome measures were daytime sleepiness (ESS), sleep quality (Pittsburgh Sleep Quality Index [PSQI]), quality of life (Calgary Sleep Apnea Quality of Life Index [SAQLI], 36-Item Short-Form Health Survey [SF-36], BP, and CPAP adherence after 4 weeks.

Results

After 4 weeks of CPAP therapy, there were no significant differences in ESS (PSG 6.4 ± 3.8 vs home monitoring [HM] 6.5 ± 3.8, P = .71), PSQI (PSG 5.4 ± 3.1 vs HM 6.2 ± 3.4, P = .30), SAQLI (PSG 4.5 ± 1.1 vs HM 4.6 ± 1.1, P = .85), SF-36 vitality (PSG 62.2 ± 23.3 vs HM 64.1 ± 18.4, P = .79), SF-36 HM (PSG 84.0 ± 10.4 vs HM 81.3 ± 14.9, P = .39), and BP (PSG 129/84 ± 11/0 vs HM 125/81 ± 13/9, P = .121). There was no difference in CPAP adherence (PSG 5.6 ± 1.7 h/night vs HM 5.4 ± 1.0 h/night, P = .49).

Conclusions

Compared with the home-based protocol, diagnosis and treatment of OSA in the sleep laboratory does not lead to superior 4-week outcomes in sleepiness scores, sleep quality, quality of life, BP, and CPAP adherence.

Trial registration

clinicaltrials.gov; Identifier: NCT00139022

Section snippets

Subjects

Adult outpatients with suspected OSA referred to the participating sleep medicine physicians (R. P. S., J. R., B. M.) at a tertiary outpatient sleep disorders clinic were eligible to take part in the study. The inclusion criteria were: age > 18 years, symptoms of OSA (at least two of the following: excessive daytime somnolence (Epworth Sleepiness Scale [ESS] > 10), witnessed apneas, snoring), and residence within a 1-h drive from the study center. Exclusion criteria were: respiratory or heart

Results

The study flow chart is presented in Figure 1. Two hundred and seventy consecutive adult patients referred to the outpatient sleep disorders clinic at the University of Saskatchewan, Saskatoon, Canada, with suspected OSA were screened. One hundred and two met the inclusion criteria and were randomized (age, 47.4 ± 11.4 years; 63 men; BMI, 32.3 ± 6.3 kg/m2; ESS, 12.5 ± 4.3; systolic BP, 131.0 ± 16 mm Hg; diastolic BP, 85 ± 9 mm Hg). There was no difference in age, sex distribution, BMI, and ESS

Discussion

Our study results indicate that in-laboratory diagnosis and therapy for OSA, using primarily a split-night PSG, does not lead to superior 4-week outcomes (subjective somnolence, arterial BP, sleep quality, and quality of life) when compared with home-based diagnosis and treatment. Patients suspected to have OSA who were randomized to diagnosis and therapy at home had similar improvements in subjective sleepiness, quality of life scores, and arterial BP after 4 weeks of CPAP therapy.

Acknowledgments

Author contributions: Dr Skomro: participated in the study design, subject recruitment, data analysis, and manuscript preparation and review.

Dr Gjevre: participated in the study design, subject recruitment, data analysis, and manuscript preparation and review.

Dr Reid: participated in the study design, subject recruitment, data analysis, and manuscript preparation and review.

Dr McNab: participated in the study design, subject recruitment, data analysis, and manuscript preparation and review.

Dr

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    Funding/Support: The financial support for this study was provided by the Kelsey Trail Health Region, the Lung Association of Saskatchewan, and Saskatoon Health Region.

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).

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