Comparison of CPAP Titration at Home or the Sleep Laboratory in the Sleep Apnea Hypopnea Syndrome

Abstract Purpose Diagnosis and treatment of obstructive sleep apnea are traditionally performed in sleep laboratories with polysomnography (PSG) and are associated with significant waiting times for patients and high cost. We investigated if initiation of auto-titrating CPAP (APAP) treatment at home in patients with obstructive sleep apnea (OSA) and subsequent telemonitoring by a homecare provider would be non-inferior to in-lab management with diagnostic PSG, subsequent in-lab APAP initiation, and standard follow-up regarding compliance and disease-specific quality of life. Methods This randomized, open-label, single-center study was conducted in Germany. Screening occurred between December 2013 and November 2015. Eligible patients with moderate-to-severe OSA documented by polygraphy (PG) were randomized to home management or standard care. All patients were managed by certified sleep physicians. The home management group received APAP therapy at home, followed by telemonitoring. The control group received a diagnostic PSG, followed by therapy initiation in the sleep laboratory. The primary endpoint was therapy compliance, measured as average APAP usage after 6 months. Results The intention-to-treat population (ITT) included 224 patients (110 home therapy, 114 controls); the per-protocol population (PP) included 182 patients with 6-month device usage data (89 home therapy, 93 controls). In the PP analysis, mean APAP usage at 6 months was not different in the home therapy and control groups (4.38 ± 2.04 vs. 4.32 ± 2.28, p = 0.845). The pre-specified non-inferiority margin (NIM) of 0.3 h/day was not achieved (p = 0.130); statistical significance was achieved in a post hoc analysis when NIM was set at 0.5 h/day (p < 0.05). Time to APAP initiation was significantly shorter in the home therapy group (7.6 ± 7.2 vs. 46.1 ± 23.8 days; p < 0.0001). Conclusion Use of a home-based telemonitoring strategy for initiation of APAP in selected patients with OSA managed by sleep physicians is feasible, appears to be non-inferior to standard sleep laboratory procedures, and facilitates faster access to therapy.

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Split-night polysomnography at Fundación Santa Fe de Bogotá

Revista de la Facultad de Medicina ◽

10.15446/revfacmed.v67n1.66001 ◽

2019 ◽

Vol 67 (1) ◽

pp. 9-16 ◽

Cited By ~ 1

Author(s):

Edgar Osuna-Suárez ◽

Adrián Camilo Zamora-Gómez ◽

Carlos Fernando Martínez-Rubio ◽

María Camila Valencia-Mendoza ◽

Yuli Guzmán-Prado ◽

...

Keyword(s):

Positive Airway Pressure ◽

Sleep Laboratory ◽

Santa Fe ◽

Time Saving ◽

Cpap Titration ◽

Combined Use ◽

Obstructive Sleep ◽

Single Night ◽

Receive Treatment ◽

Hypopnea Syndrome

Introduction: The obstructive sleep apnea-hypopnea syndrome (OSAHS) is usually established using polysomnography (PSG). Most patients diagnosed with this condition receive treatment with continuous positive airway pressure (CPAP). The conventional approach requires performing a full-night PSG and CPAP titration over a two-night stay in a sleep laboratory, which is costly and may present scheduling difficulties. However, the combined use of polysomnography and CPAP titration in a single night, procedure known as split-night polysomnography (SNPSG), is less-expensive and is a time saving strategy for diagnosis and treatment.Objectives: To characterize the SNPSG studies conducted in the sleep laboratory of the Hospital Universitario Santa Fe de Bogotá (HUFSFB) and assess their performance in the diagnosis and treatment of OSAHS.Materials and methods: Retrospective, observational and longitudinal study performed on a sample of 221 patients.Results: 208 (94.1%) SNPSG studies were compatible with OSAHS. Most cases (54.7%) had a hypopnea apnea index (AHI) ≥30. Adequate CPAP titration was achieved in 78% of patients who had severe AHI (p=0.00).Conclusions: OSAHS was diagnosed and an adequate CPAP titration was achieved in most of the SNPSG studies of the analyzed sample.

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Usefulness of linear discriminant analysis of overnight oximetry from respiratory polygraphy at home to assist in the diagnosis of pediatric obstructive sleep apnea hypopnea syndrome

10.1183/13993003.congress-2015.pa3369 ◽

2015 ◽

Author(s):

Andrea Crespo ◽

Félix Del Campo ◽

Roberto Hornero ◽

Daniel Álvarez ◽

Joaquin Terán ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Discriminant Analysis ◽

Linear Discriminant Analysis ◽

Linear Discriminant ◽

Obstructive Sleep ◽

Respiratory Polygraphy ◽

Overnight Oximetry ◽

Hypopnea Syndrome ◽

At Home

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Auto-CPAP Titration at Home in Patients With Sleep Apnea:1, 3, or 6 Nights?

CHEST Journal ◽

10.1378/chest.10994 ◽

2010 ◽

Vol 138 (4) ◽

pp. 624A

Author(s):

Facundo Nogueira ◽

Sofía Grandval ◽

Pablo Micci

Keyword(s):

Sleep Apnea ◽

Cpap Titration ◽

At Home

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Comparison of manual and automatic CPAP titration in patients with sleep apnea/hypopnea syndrome.

American Journal of Respiratory and Critical Care Medicine ◽

10.1164/ajrccm.154.6.8970366 ◽

1996 ◽

Vol 154 (6) ◽

pp. 1755-1758 ◽

Cited By ~ 64

Author(s):

P Lloberes ◽

E Ballester ◽

J M Montserrat ◽

E Botifoll ◽

A Ramirez ◽

...

Keyword(s):

Sleep Apnea ◽

Cpap Titration ◽

Hypopnea Syndrome

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Supine sleep patterns as a part of phenotyping patients with sleep apnea—a pilot study

Sleep And Breathing ◽

10.1007/s11325-022-02567-5 ◽

2022 ◽

Author(s):

Wojciech Kukwa ◽

Jonasz Łaba ◽

Tomasz Lis ◽

Krystyna Sobczyk ◽

Ron B. Mitchell ◽

...

Keyword(s):

Sleep Apnea ◽

Pilot Study ◽

Sleep Position ◽

Sleep Laboratory ◽

Apnea Test ◽

Multiple Electrodes ◽

Median Proportion ◽

Supine Sleep ◽

Objective Study ◽

At Home

Abstract Purpose Polysomnography (PSG) is considered the best objective study to diagnose and quantify sleep disorders. However, PSG involves multiple electrodes and is usually performed in a sleep laboratory that in itself may change the physiology of sleep. One of the parameters that can change during PSG is the sleep position, leading to more supine sleep. The aim of this study was to quantify the amount of supine sleep during PSG and compare it to consecutive nights of a home sleep apnea test (HSAT) in the same patients. Methods This prospective study evaluated 22 consecutive patients undergoing PSG followed by HSAT. Sleep position was analyzed during PSG and subsequently on 2 to 6 nights (mean 3.7 nights) at home, and the amount of supine sleep was recorded during each night. Results Of 22 patients, there were 12 men (55%). The median age was 60.0 years for women and 45.5 years for men. Median proportion of supine sleep during PSG and HSAT was 61% and 26% (p < 0.001), respectively. Four “phenotypes” were identified according to their sleep position during PSG and HSAT, with 5 patients sleeping mainly supine during all nights, 7 patients sleeping mainly non-supine during all nights, 3 patients sleeping in different positions during each night, and 7 patients sleeping supine during PSG but non-supine at home, during HSAT. Conclusions There is a higher proportion of supine sleep during PSG compared to home sleep. We identified a subgroup of patients who slept mainly supine during PSG and mainly non-supine during HSAT. PSG may overestimate OSA severity in a specific phenotype of patients.

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