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Original Research: SLEEP DISORDERS |

Does Home Sleep Testing Impair Continuous Positive Airway Pressure Adherence in Patients With Obstructive Sleep Apnea?

Christine F. Lettieri, MD; Christopher J. Lettieri, MD, FCCP; Kevin Carter, DO
Author and Funding Information

From the Department of Family Medicine (Dr C. F. Lettieri), DeWitt Army Community Hospital, Fort Belvoir, VA; the Department of Pulmonary, Critical Care, and Sleep Medicine (Drs C. J. Lettieri and Carter), Walter Reed Army Medical Center, Washington DC; and the Department of Family Medicine (Dr C. F. Lettieri), and the Department of Medicine (Dr C. J. Lettieri), Uniformed Services University, Bethesda, MD.

Correspondence to: Christine F. Lettieri, MD, Department of Family Medicine, DeWitt Army Community Hospital, 9501 Farrell Rd, Fort Belvoir, VA 22060; e-mail: Christine.Lettieri@us.army.mil


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


© 2011 American College of Chest Physicians


Chest. 2011;139(4):849-854. doi:10.1378/chest.10-1060
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Background:  The increasing recognition of obstructive sleep apnea (OSA) and demand for polysomnography has created a need for home sleep testing (HST) using unattended diagnostic and titration studies. Although these studies increase access to care and reduce cost, the limited interaction with sleep laboratories may negatively affect positive airway pressure (PAP) adherence. We sought to determine the difference in PAP use between HST and traditional in-laboratory studies.

Methods:  This observational cohort study included 210 patients with OSA classified into three equal groups. Following preestablished guidelines, group 1 underwent unattended, type III home diagnostic and unattended home auto-adjustable PAP (APAP) titrations; group 2 underwent in-laboratory, type I diagnostic and continuous PAP titration studies; group 3 underwent type I diagnostic and APAP titration studies. Group 1 was primarily managed and educated in a primary care clinic, whereas groups 2 and 3 received extensive education in an academic sleep medicine center. Objective measures of PAP use during the first 4 to 6 weeks of therapy were compared between groups.

Results:  Type of study and location of care did not affect PAP adherence. PAP was used for 70%, 73%, and 72% of nights in groups 1, 2, and 3, respectively (P = .94). Mean hours of nightly use (4.4 ± 2.0 h, 4.7 ± 1.5 h, and 4.6 ± 1.5 h; P = .98) was also similar. Regular use was observed in 54%, 51%, and 50% of subjects (P = .84). Discontinuation rates were similar between groups.

Conclusions:  PAP usage did not differ between those undergoing HST vs in-laboratory studies. HST offers a more accessible and cost-effective alternative without compromising therapeutic adherence.


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