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Cited by 190Obstructive Sleep Apnea ResearchSleep and related disordersRespiratory Support and Mechanisms

Portable Monitoring and Autotitration versus Polysomnography for the Diagnosis and Treatment of Sleep Apnea

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Richard Barnett Berry, Gilbert Hill, BS, Linda Thompson, Valorea McLaurin·2008·Sleep
DOI 10.5665/sleep/31.10.1423PMC PMC2572748
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Abstract

STUDY OBJECTIVES: To compare a clinical pathway using portable monitoring (PM) for diagnosis and unattended autotitrating positive airway pressure (APAP) for selecting an effective continuous positive airway pressure (CPAP) with another pathway using polysomnography (PSG) for diagnosis and treatment of obstructive sleep apnea (OSA). DESIGN: Randomized parallel group SETTING: Veterans Administration Medical Center PATIENTS: 106 patients with daytime sleepiness and a high likelihood of having OSA MEASUREMENTS AND RESULTS: The AHI in the PM-APAP group was 29.2 +/- 2.3/h and in the PSG group was 36.8 +/- 4.8/h (P= NS). Patients with an AHI > or = 5 were offered CPAP treatment. Those accepting treatment (PM-APAP 45, PSG 43) were begun on CPAP using identical devices at similar mean pressures (11.2 +/- 0.4 versus 10.9 +/- 0.5 cm H2O). At a clinic visit 6 weeks after starting CPAP, 40 patients in the PM-APAP group (78.4% of those with OSA and 88.8% started on CPAP) and 39 in the PSG arm (81.2% of those with OSA and 90.6% of those started on CPAP) were using CPAP treatment (P = NS). The mean nightly adherence (PM-APAP: 5.20 +/- 0.28 versus PSG: 5.25 +/- 0.38 h/night), decrease in Epworth Sleepiness Scale score (-6.50 +/- 0.71 versus -6.97 +/- 0.73), improvement in the global Functional Outcome of Sleep Questionnaire score (3.10 +/- 0.05 versus 3.31 +/- 0.52), and CPAP satisfaction did not differ between the groups. CONCLUSIONS: A clinical pathway utilizing PM and APAP titration resulted in CPAP adherence and clinical outcomes similar to one using PSG.

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Crossref · 10.5665/sleep/31.10.1423

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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 [83]

    The Discussion describes one study that randomized 106 patients to portable-monitoring/autotitration or PSG pathways. It reports similar improvements in subjective sleepiness, and the reported outcomes include changes in Epworth Sleepiness Scale scores. The paper does not report a meta-analysis of seven RCTs. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • 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 [83]

    The CPAP Treatment and Adherence section reports that nights with more than four hours of use were around 70% in both arms, with no statistically significant difference. This supports the adherence measure and a small or absent difference, but the paper reports one trial, not a meta-analysis of five RCTs, and the cited passage does not establish an increase in the HSAT arm. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • 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 [83]

    Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

    Experimental — accuracy not yet measured

  • 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 [83]

    The paper describes its randomized comparison of two clinical pathways and, in Diagnostic Testing (page unavailable), reports numbers of split studies, repeat portable-monitoring studies, and crossover studies—information relevant to resource use. Its text does not establish that it was the only one of four RCTs to provide such information, or identify that set of four trials. (LLM, conf=0.78)

    Experimental — accuracy not yet measured

  • Among the four RCTs most generalizable to clinical practice, three studies required use of PSG if HSAT was inconclusive and after 1 or 2 failed APAP trials.

    “Among the four RCTs most generalizable to clinical practice, three studies83–85 required use of PSG if HSAT was inconclusive (did not provide adequate data or showed a low AHI after 1 or 2 unsuccessful attempts) and after 1 or 2 failed APAP trials (e.g., insufficient use, elevated residual AHI, persistent large leak).”

    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 [83]

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Cites

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Research works printed but not linked: 20

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Cited by

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Authors
Berry, R. B., Gilbert Hill, B., Thompson, L., & McLaurin, V.
Affiliations
  • University of Florida (US)
  • Malcom Randall VA Medical Center (US)
Corresponding author
Richard Barnett Berry
ORCID
Richard Barnett Berry
Venue
Sleep
Publisher
Oxford University Press (OUP)
Published
2008-10-01
Volume
31
Issue
10
Pages
1423-31
ISSN
  • 0161-8105 (ISSN-L)
  • 1550-9109
DOI
10.5665/sleep/31.10.1423
PMC
PMC2572748
OpenAlex
W2115200921
Cited by
190
References
3
Citations by year
2025: 5 · 2024: 4 · 2023: 8 · 2022: 4 · 2021: 7 · 2020: 11 · 2019: 10 · 2018: 6 · 2017: 13 · 2016: 10 · 2015: 25 · 2014: 12 · 2013: 18 · 2012: 14
FWCI
8.95
Type
journal article
Language
en
Open access
Locations
  • SLEEP (publishedVersion)
  • PubMed Central (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, portable monitoring, paracetamol, CPAP titration, polysomnography, CPAP adherence, daytime sleepiness, veterans, care pathways, Epworth Sleepiness Scale
MeSH terms
Equipment Design, Female, Hospitals, Veterans, Humans, Male, Middle Aged, Patient Satisfaction, Polysomnography, Monitoring, Ambulatory, Critical Pathways, Sleep Apnea, Obstructive, Continuous Positive Airway Pressure

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