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Original Research: SLEEP MEDICINE |

Outcomes of Home-Based Diagnosis and Treatment of Obstructive Sleep Apnea

Robert P. Skomro, MD, FCCP; John Gjevre, MD, FCCP; John Reid, MD, FCCP; Brian McNab, MD, FCCP; Sunita Ghosh, PhD; Maryla Stiles, DVM; Ruzica Jokic, MD; Heather Ward, MD, FCCP; David Cotton, MD, FCCP
Author and Funding Information

From the Department of Medicine (Drs Skomro, Gjevre, Reid, Stiles, Ward, and Cotton), and the Department of Community Health and Epidemiology (Dr Ghosh), The University of Saskatchewan, Saskatoon, SK; the Department of Medicine (Dr McNab), University of Alberta, Edmonton, AB; and the Department of Psychiatry (Dr Jokic), Queens University, Kingston, ON, Canada.

Correspondence to: Robert P. Skomro, MD, FCCP, Room 563 Ellis Hall, Division of Respiratory Critical Care and Sleep Medicine, Royal University Hospital, Saskatoon, SK, S7N 0W8, Canada; e-mail: r.skomro@usask.ca


For editorial comment see page 245

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).


© 2010 American College of Chest Physicians


Chest. 2010;138(2):257-263. doi:10.1378/chest.09-0577
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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

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