title: The impact of split-night versus traditional sleep studies on CPAP compliance.
abstract: BACKGROUND
  Split-night polysomnography allows for the diagnosis of obstructive sleep apnea and titration of continuous positive airway pressure in a single study. However, there is concern that split-night studies do not provide sufficient time for optimal continuous positive airway pressure (CPAP) titration, which may lead to a poor initial experience with CPAP and potentially, worse adherence. Our goal was to determine whether CPAP use, after a split-night examination, is comparable to the use following separate diagnostic and titration studies.
  
  
  METHODS
  We included consecutive patients presenting for follow-up 4-6 weeks after initiating CPAP therapy. Objective measures of CPAP use were recorded, and adherence to therapy was analyzed based on the initial method of diagnosis and titration-split-night versus dual-night study.
  
  
  RESULTS
  A total of 400 patients (78% male, mean age 47 +/- 8 years) were included. Among the patients, 267 and 133 underwent split- and dual-night studies, respectively. The groups were similar at baseline; however, the average apnea-hypopnea index was significantly higher in the split-night group. Mean number of days between diagnosis and titration in the dual-night group was 80.5 days. There was no difference in therapeutic adherence between groups as measured by percentage of nights used (78.7% vs 77.5%; p = 0.42), hours per night used (3.9 vs 3.9; p = 0.95), or percentage of patients using continuous positive airway pressure for >4 hours per night for >70% of nights (52.9% vs 51.8%; p = 0.81). There was no difference in use after adjusting for severity of disease.
  
  
  CONCLUSIONS
  Split-night polysomnography does not adversely affect short-term continuous positive airway pressure adherence in patients with obstructive sleep apnea.
authors.affiliation: Department of Internal Medicine, Walter Reed Army Medical Center, Washington, DC, USA. jacob.collen@amedd.army.mil
authors.forename: Jacob
authors.initials: J
authors.lastname: Collen
authors.forename: Aaron
authors.initials: A
authors.lastname: Holley
authors.forename: Christopher
authors.initials: C
authors.lastname: Lettieri
authors.forename: Anita
authors.initials: A
authors.lastname: Shah
authors.forename: Stuart
authors.initials: S
authors.lastname: Roop
mesh_terms: D000328:Adult; D001071:Appointments and Schedules; D015992:Body Mass Index; D045422:Continuous Positive Airway Pressure; D004219:District of Columbia; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D010349:Patient Compliance; D017286:Polysomnography / Q000379:methods*; D011237:Predictive Value of Tests; D011785:Quality Assurance, Health Care; D020181:Sleep Apnea, Obstructive / Q000097:blood / Q000175:diagnosis* / Q000628:therapy*
chemical_list: D010100:Oxygen