PURPOSE:Portable monitor (PM) and automatic CPAP (auto-CPAP) devices have been used for the treatment of obstructive sleep apnea syndrome (OSAS), but unattended inpatient data is lacking. We aim to assess the effectiveness of PM with auto-CPAP titration in highly suspected OSAS (CPAP-naive) subjects in an inpatient setting.
METHODS:Hospitalized patients with a high probability of OSAS previously determined by validated clinical prediction models. Each subject underwent an overnight unattended auto-CPAP titration with PM. Acceptance and tolerance to auto-CPAP was assessed with a post-study questionnaire. Patients were followed up with an attended split polysomnography (PSG).
RESULTS:138 patients were screened. 33 patients were enrolled (24%) and underwent PM with auto-CPAP titration. Mean BMI was 45.8 (SD±12.4). Quality of PM recordings was very good in 20 patients (62.5%), suboptimal but readable in 7 (21.8%), and barely readable in 5 (15.6%). On a scale of 1 (worst) to 5 (best), most patients felt the same or better quality sleep compared to an average night by using auto-CPAP (mean 3.90; 95% CI 3.51–4.30). 28 of 33 patients (84.8%) were willing to use CPAP at home. 16 of 18 (88.9%) patients were diagnosed with OSAS by follow-up attended overnight split-PSG. There were no statistically significant differences in CPAP pressure levels obtained by auto-CPAP vs. attended split-PSG (Mean difference -1.9 cm H20; 95% CI -4.23 to 0.43), but some pressure differences were clinically significant (Median: -3.0, range -7.2 to 7.0).
CONCLUSION:These findings suggest that unattended auto-CPAP titration in this population is well tolerated, and most patients are willing to use CPAP at home. No statistically significant differences in optimal CPAP pressures were obtained between unattended PM with auto-CPAP and standard sleep laboratory CPAP titration. Quality of PM with auto-CPAP recordings varied.
CLINICAL IMPLICATIONS:We recommend a careful assessment of auto-CPAP titration and PM recording by a sleep specialist in this setting. Follow-up attended PSG in all patients is also recommended. Further studies addressing the accuracy of auto-CPAP titration in this setting are warranted.
DISCLOSURE:Haven Malish, Other This project was partially funded by equipment support by Respironics™.; No Product/Research Disclosure Information