Comparison of CPAP titration at home or the sleep laboratory in the sleep apnea hypopnea syndrome.
OBJECTIVE
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.


METHODS
Prospective, randomized, single-blind, parallel-group, controlled trial


METHODS
Regional sleep center and patients' homes.


METHODS
Two hundred CPAP-naïve patients with OSAHS requiring CPAP treatment.


METHODS
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.


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.
Cross
Melanie D
MD
Department of Sleep Medicine, Royal Infirmary of Edinburgh, Scotland, UK.
Vennelle
Marjorie
M
Engleman
Heather M
HM
White
Sandra
S
Mackay
Thomas W
TW
Twaddle
Sarah
S
Douglas
Neil J
NJ
D002138:Calibration; D045422:Continuous Positive Airway Pressure / Q000295:instrumentation*; D019544:Equipment Failure Analysis; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006699:Home Care Services; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D017286:Polysomnography; D011446:Prospective Studies; D016037:Single-Blind Method; D020181:Sleep Apnea, Obstructive / Q000628:therapy*; D013689:Telephone