title: Comparison of CPAP titration at home or the sleep laboratory in the sleep apnea hypopnea syndrome.
abstract: 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.
authors.affiliation: Department of Sleep Medicine, Royal Infirmary of Edinburgh, Scotland, UK.
authors.forename: Melanie D
authors.initials: MD
authors.lastname: Cross
authors.forename: Marjorie
authors.initials: M
authors.lastname: Vennelle
authors.forename: Heather M
authors.initials: HM
authors.lastname: Engleman
authors.forename: Sandra
authors.initials: S
authors.lastname: White
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Mackay
authors.forename: Sarah
authors.initials: S
authors.lastname: Twaddle
authors.forename: Neil J
authors.initials: NJ
authors.lastname: Douglas
mesh_terms: 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