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Original Research: SLEEP DISORDERS |

The Impact of Sleep Consultation Prior to a Diagnostic Polysomnogram on Continuous Positive Airway Pressure AdherenceSleep Consultation and Treatment Adherence Sleep Consultation and Treatment Adherence

Sushmita Pamidi, MD; Kristen L. Knutson, PhD; Farbod Ghods, MD; Babak Mokhlesi, MD, FCCP
Author and Funding Information

From the Sleep Disorders Center, Section of Pulmonary and Critical Care, Department of Medicine, University of Chicago, Chicago, IL.

Correspondence to: Babak Mokhlesi, MD, FCCP, Sleep Disorders Center and Sleep Fellowship Program, Section of Pulmonary and Critical Medicine, Department of Medicine, 5841 S Maryland Ave, MC 6076/Room M630, Chicago, IL 60637; e-mail: bmokhles@medicine.bsd.uchicago.edu


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

Funding/Support: The authors have reported to CHEST that no funding was received for this study.


© 2012 American College of Chest Physicians


Chest. 2012;141(1):51-57. doi:10.1378/chest.11-0709
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Background:  Polysomnograms (PSGs) are routinely ordered by nonsleep specialists. However, it is unknown whether a sleep specialist consultation prior to a diagnostic PSG influences adherence to continuous positive airway pressure (CPAP) therapy.

Methods:  This study was done at the University of Chicago Sleep Disorders Center and included 403 patients with obstructive sleep apnea who had CPAP adherence data available. CPAP was set up at home, and objective adherence was remotely monitored during the first 30 days of therapy. Physicians who ordered PSGs were divided into two groups: sleep specialists and nonsleep specialists.

Results:  Patients were aged 52.5 ± 14 years, 47% were men, and 54% were African American. Mean daily CPAP use was greater in patients who were referred by sleep specialists (n = 105, 279 ± 179 min/d) than in patients referred by nonsleep specialists (n = 298, 219 ± 152 min/d, P = .005). In the linear regression model adjusting for several covariates, only two predictors were significantly associated with CPAP adherence. A sleep specialist consultation prior to the diagnostic PSG was associated with 58.2 min more per day (P = .002), and African American race was associated with 56.0 min less per day (P = .002) of CPAP use.

Conclusions:  In this cohort study, CPAP adherence was significantly higher with a sleep specialist consultation prior to the diagnostic PSG. In addition, African American race was associated with worse adherence to therapy. A better understanding of predictors of CPAP adherence may be useful in identifying patients who may benefit from a sleep specialist consultation prior to ordering a diagnostic PSG.

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