Outcomes of Home-Based Diagnosis and Treatment of Obstructive Sleep Apnea
Abstract
Background Home diagnosis and therapy for obstructive sleep apnea (OSA) may improve access to testing and continuous positive airway pressure (CPAP) treatment. We compared subjective sleepiness, sleep quality, quality of life, BP, and CPAP adherence after 4 weeks of CPAP therapy in subjects in whom OSA was diagnosed and treated at home and in those evaluated in the sleep laboratory. Methods A randomized trial was performed consisting of home-based level 3 testing followed by 1 week of auto-CPAP and fixed-pressure CPAP based on the 95% pressure derived from the auto-CPAP device, and in-laboratory polysomnography (PSG) (using mostly split-night protocol) with CPAP titration; 102 subjects were randomized (age, 47.4 +/- 11.4 years; 63 men; BMI, 32.3 +/- 6.3 kg/m(2); Epworth Sleepiness Scale [ESS]: 12.5 +/- 4.3). The outcome measures were daytime sleepiness (ESS), sleep quality (Pittsburgh Sleep Quality Index [PSQI]), quality of life (Calgary Sleep Apnea Quality of Life Index [SAQLI], 36-Item Short-Form Health Survey [SF-36], BP, and CPAP adherence after 4 weeks. Results After 4 weeks of CPAP therapy, there were no significant differences in ESS (PSG 6.4 +/- 3.8 vs home monitoring [HM] 6.5 +/- 3.8, P = .71), PSQI (PSG 5.4 +/- 3.1 vs HM 6.2 +/- 3.4, P = .30), SAQLI (PSG 4.5 +/- 1.1 vs HM 4.6 +/- 1.1, P = .85), SF-36 vitality (PSG 62.2 +/- 23.3 vs HM 64.1 +/- 18.4, P = .79), SF-36 HM (PSG 84.0 +/- 10.4 vs HM 81.3 +/- 14.9, P = .39), and BP (PSG 129/84 +/- 11/0 vs HM 125/81 +/- 13/9,…
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A meta-analysis of seven RCTs compared changes in patient-reported sleepiness, using the ESS, in patients diagnosed by HSAT or PSG, followed by PAP titration.
“A meta-analysis of seven RCTs compared changes in patient-reported sleepiness, using the ESS, in patients diagnosed by HSAT or PSG, followed by PAP titration”
From Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline (2017) · cites this paper as [110]
Among the four RCTs most generalizable to clinical practice, only one provided information on resource utilization.
“Among the four RCTs most generalizable to clinical practice,83–85,110 only one provided this information.84”
From Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline (2017) · cites this paper as [110]
When determining adherence by number of nights with greater than 4 hours of use, meta-analysis of five RCTs found a clinically insignificant trend towards increased CPAP adherence in the HSAT arm versus the PSG arm.
“When determining adherence by number of nights with greater than 4 hours of use, meta-analysis of five RCTs found a clinically insignificant trend towards increased CPAP adherence in the HSAT arm versus the PSG arm”
From Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline (2017) · cites this paper as [110]
In one of the four RCTs most generalizable to clinical practice, both HSAT and PSG were performed for each patient, and 76% preferred HSAT.
“In one of the four RCTs most generalizable to clinical practice, both HSAT and PSG were performed for each patient, and 76% preferred HSAT.110”
From Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline (2017) · cites this paper as [110]
Six RCTs evaluated CPAP adherence (mean hours of use per night); meta-analysis found no significant difference between the two assessment pathways.
“Six RCTs evaluated CPAP adherence (mean hours of use per night); meta-analysis found no significant difference between the two assessment pathways”
From Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline (2017) · cites this paper as [110]
Six RCTs, using various validated instruments (i.e., FOSQ, SAQLI, and SF-36), compared QOL in patients diagnosed by HSAT or PSG, followed by PAP titration.
“Six RCTs, using various validated instruments (i.e., FOSQ, SAQLI, and SF-36), compared QOL in patients diagnosed by HSAT or PSG, followed by PAP titration.”
From Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline (2017) · cites this paper as [110]
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- Authors
- Skomro, R. P., Gjevre, J., Reid, J., McNab, B., Ghosh, S., Stiles, M., Jokic, R., Ward, H., & Cotton, D.
- Affiliations
- University of Saskatchewan (CA)
- University of Alberta (CA)
- Corresponding author
- Skomro, Robert P.
- Venue
- Chest
- Publisher
- Elsevier BV
- Published
- 2010-08
- Volume
- 138
- Issue
- 2
- Pages
- 257-263
- ISSN
- 0012-3692 (ISSN-L)
- OpenAlex
- W2152468079
- Cited by
- 125
- References
- 0
- Citations by year
- 2026: 3 · 2025: 6 · 2024: 4 · 2023: 5 · 2022: 5 · 2021: 4 · 2020: 5 · 2019: 3 · 2018: 6 · 2017: 11 · 2016: 8 · 2015: 11 · 2014: 9 · 2013: 14 · 2012: 13
- FWCI
- 8.94
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- CHEST Journal (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, home sleep testing, CPAP therapy, auto-CPAP, CPAP adherence, daytime sleepiness, sleep quality, quality of life, blood pressure, CPAP titration, home-based diagnosis, polysomnography comparison, Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, SF-36 vitality
- MeSH terms
- Adult, Female, Humans, Male, Middle Aged, Quality of Life, Sleep, Treatment Outcome, Polysomnography, Monitoring, Ambulatory, Sleep Apnea, Obstructive, Continuous Positive Airway Pressure
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