PURPOSE: The increasing recognition of obstructive sleep apnea (OSA) is creating tremendous demands for in-lab polysomnograms. Home sleep testing (HST) was recently approved for the evaluation of suspected OSA. While these studies increase access to care and reduce cost, the limited interaction with sleep labs may negatively affect positive airway pressure (PAP) adherence. We sought to determine the difference in PAP use between HST and traditional, in-lab studies.
METHODS: Observational cohort study of 210 OSA patients classified into three equal groups. Group 1 underwent in-laboratory, type I diagnostic and CPAP titration studies; Group 2 underwent type 1 diagnostic and unattended home auto-adjustable positive airway pressure (APAP) titrations; Group 3 underwent unattended, type 3 home diagnostic and APAP titration studies. Groups 1 and 2 received extensive education in an academic Sleep Medicine Clinic while group 3 was managed and educated in a primary-care clinic. Objective measures of PAP use during the first 4-6 weeks of therapy were compared between groups.
RESULTS: The majority (68.1%) of the cohort were men. Mean age was 48.1±10.2 years and mean AHI was 21.8±9.3. Location of the study and degree of education did not affect PAP adherence. PAP was used for 73%, 72% and 70% of nights in Groups 1, 2 and 3, respectively (p=0.94). Mean hours of nightly use was also similar. PAP was used for 4.7±1.5, 4.6±1.5, and 4.4±2.0 hours in Groups 1, 2 and 3, respectively (p=0.98). Regular use of PAP, defined as use on >70% of nights for >4 hours per night, was observed in 53%, 53% and 57% of subjects in Groups 1, 2 and 3, respectively (p=0.84). Abandonment of therapy was also similar between groups and occurred in 8.6%, 10.0% and 12.9% in groups 1, 2 and 3 (p=0.78).
CONCLUSION: Despite less lab contact and education, PAP usage did not differ between those undergoing HST versus traditional in-lab studies.
CLINICAL IMPLICATIONS: HST offers a reliable and cost-effective alternative that does not appear to negatively influence acceptance of or adherence to therapy.
DISCLOSURE: Christine Lettieri, No Financial Disclosure Information; No Product/Research Disclosure Information