Comparison of CPAP Titration at Home or the Sleep Laboratory in the Sleep Apnea Hypopnea Syndrome
Abstract
STUDY OBJECTIVES: Continuous positive airway pressure (CPAP) for the treatment of obstructive sleep apnea hypopnea syndrome (OSAHS) is conventionally started after in-laboratory overnight titration. This use of sleep laboratory space is both costly and limits access for diagnostic studies. This study aimed to evaluate whether automated CPAP titration in the home produced patient outcomes equal to those following laboratory-based automated CPAP titration. The main outcomes were Epworth Sleepiness Scale score, objective daytime sleepiness (Oxford SLEep Resistance test or OSLER test), and CPAP use; we also performed quality-of-life questionnaires: Functional Outcomes of Sleep Questionnaire and SF-36. DESIGN: Prospective, randomized, single-blind, parallel-group, controlled trial SETTING: Regional sleep center and patients' homes. PATIENTS: Two hundred CPAP-naïve patients with OSAHS requiring CPAP treatment. INTERVENTIONS: One hundred patients were randomly assigned to a standard 1-night in-hospital CPAP titration and 100 to 3 nights' home CPAP titration and then issued with fixed pressure CPAP. Data were analyzed on an intention-to-treat basis. MEASUREMENTS AND RESULTS: The patient groups did not differ at baseline. The CPAP pressures defined at titration (mean+/- SEM: 10.6+/-0.2, 10.4+/-0.2 cm H20, p = .19), number of mask leaks, and initial acceptance rates were similar in the sleep-laboratory and home-titrated groups. At 3-month follow-up, there was no significant difference in CPAP use (mean+/-SEM: 4.39+/-0.25, 4.38+/-0.25 h/night; p > .9), Epworth Sleepiness Scale score (9.5+/-0.5, 8.5+/-0.5, p = .14), OSLER, Functional Outcomes of Sleep Questionnaire, or SF-36 between the sleep-laboratory and home-titrated groups. CONCLUSIONS: Home-based automated CPAP titration is as effective as automatic in-laboratory titrations in initiating treatment for OSAHS.
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Meta-analysis of RCTs demonstrated no clinically significant difference in sleep-related quality of life when comparing PAP initiation using home APAP versus an in-laboratory titration.
“A meta-analysis combining 2 RCTs measuring sleep-related QOL with FOSQ, 175,176 2 RCTs measuring sleep-related QOL with SAQLI, 178,182 and one RCT 180 measuring both FOSQ and SAQLI demonstrated no clinically significant difference in sleep-related QOL when comparing PAP initiation using home APAP versus an in-laboratory titration”
From Treatment of Adult Obstructive Sleep Apnea With Positive Airway Pressure: An American Academy of Sleep Medicine Systematic Review, Meta-Analysis, and GRADE Assessment (2019) · cites this paper as [175]
The Three-Month Assessment (p. 2) identifies this as an RCT that measured sleep-related quality of life with FOSQ, and the Results (p. 3) report no statistical difference between home and laboratory titration. The paper measured SF-36, not SAQLI, alongside FOSQ. It reports its own trial, not the cited meta-analysis or a test of clinical significance. (LLM, conf=0.88)
Experimental — accuracy not yet measuredTwo RCTs demonstrated no clinically significant difference in general quality of life as assessed by the SF-36 mental component summary, physical component summary, and vitality scores when comparing home APAP versus an in-laboratory titration.
“Two RCTs 175,180 demonstrated no clinically significant difference in general QOL as assessed by the SF-36 mental component summary, physical component summary, and vitality scores when comparing home APAP versus an in-laboratory titration”
From Treatment of Adult Obstructive Sleep Apnea With Positive Airway Pressure: An American Academy of Sleep Medicine Systematic Review, Meta-Analysis, and GRADE Assessment (2019) · cites this paper as [175]
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Experimental — accuracy not yet measuredSix studies evaluated cost, of which three reported a slightly reduced cost for a combined home-based diagnostic and treatment pathway, and three reported a lower cost for home APAP compared to in-laboratory titrations.
“Six studies evaluated cost, 35,175,177,[179][180][181] of which three 35,180,181 reported a slightly reduced cost for a combined home-based diagnostic and treatment pathway, and three 175,177,179 reported a lower cost for home APAP compared to in-laboratory titrations.”
Out-of-pocket costs to patients may be lower with either split or whole-night in-laboratory PAP titration due to payor coverage policies in certain instances.
“Despite the greater cost-effectiveness of homebased APAP initiation, 175,177,179 out-of-pocket costs to patients may be lower with either split or whole-night in-laboratory PAP titration due to payor coverage policies in certain instances.”
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- Authors
- Cross, M. D., Vennelle, M., Engleman, H. M., White, S., Mackay, T. W., Twaddle, S., & Douglas, N. J.
- Affiliations
- Edinburgh Royal Infirmary (GB)
- ORCID
- Mackay, Thomas W.
- Venue
- Sleep
- Publisher
- Oxford University Press (OUP)
- Published
- 2006-11
- Volume
- 29
- Issue
- 11
- Pages
- 1451-1455
- ISSN
- 0161-8105 (ISSN-L)
- 1550-9109
- OpenAlex
- W1901193752
- Semantic Scholar
- 71e67e1b000daaf4c62b840810587e68b9642589
- Cited by
- 46
- References
- 21
- Citations by year
- 2026: 1 · 2023: 1 · 2022: 2 · 2021: 1 · 2020: 1 · 2019: 2 · 2018: 1 · 2017: 2 · 2016: 4 · 2013: 1 · 2012: 6
- FWCI
- 3.09
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- SLEEP (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
- Keywords
- obstructive sleep apnea-hypopnea syndrome, CPAP titration, continuous positive airway pressure, daytime sleepiness, Epworth Sleepiness Scale, CPAP adherence, quality of life
- MeSH terms
- Calibration, Feasibility Studies, Female, Follow-Up Studies, Home Care Services, Humans, Male, Middle Aged, Prospective Studies, Telephone, Single-Blind Method, Patient Satisfaction, Polysomnography, Equipment Failure Analysis, Sleep Apnea, Obstructive, Continuous Positive Airway Pressure
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