title: Outcomes of home-based diagnosis and treatment of obstructive sleep apnea.
abstract: BACKGROUND
  Home diagnosis and therapy for obstructive sleep apnea (OSA) may improve access to testing and continuous positive airway pressure (CPAP) treatment. We compared subjective sleepiness, sleep quality, quality of life, BP, and CPAP adherence after 4 weeks of CPAP therapy in subjects in whom OSA was diagnosed and treated at home and in those evaluated in the sleep laboratory.
  
  
  METHODS
  A randomized trial was performed consisting of home-based level 3 testing followed by 1 week of auto-CPAP and fixed-pressure CPAP based on the 95% pressure derived from the auto-CPAP device, and in-laboratory polysomnography (PSG) (using mostly split-night protocol) with CPAP titration; 102 subjects were randomized (age, 47.4 +/- 11.4 years; 63 men; BMI, 32.3 +/- 6.3 kg/m(2); Epworth Sleepiness Scale [ESS]: 12.5 +/- 4.3). The outcome measures were daytime sleepiness (ESS), sleep quality (Pittsburgh Sleep Quality Index [PSQI]), quality of life (Calgary Sleep Apnea Quality of Life Index [SAQLI], 36-Item Short-Form Health Survey [SF-36], BP, and CPAP adherence after 4 weeks.
  
  
  RESULTS
  After 4 weeks of CPAP therapy, there were no significant differences in ESS (PSG 6.4 +/- 3.8 vs home monitoring [HM] 6.5 +/- 3.8, P = .71), PSQI (PSG 5.4 +/- 3.1 vs HM 6.2 +/- 3.4, P = .30), SAQLI (PSG 4.5 +/- 1.1 vs HM 4.6 +/- 1.1, P = .85), SF-36 vitality (PSG 62.2 +/- 23.3 vs HM 64.1 +/- 18.4, P = .79), SF-36 HM (PSG 84.0 +/- 10.4 vs HM 81.3 +/- 14.9, P = .39), and BP (PSG 129/84 +/- 11/0 vs HM 125/81 +/- 13/9, P = .121). There was no difference in CPAP adherence (PSG 5.6 +/- 1.7 h/night vs HM 5.4 +/- 1.0 h/night, P = .49).
  
  
  CONCLUSIONS
  Compared with the home-based protocol, diagnosis and treatment of OSA in the sleep laboratory does not lead to superior 4-week outcomes in sleepiness scores, sleep quality, quality of life, BP, and CPAP adherence.
  
  
  BACKGROUND
  clinicaltrials.gov; Identifier: NCT00139022.
authors.affiliation: Division of Respiratory Critical Care and Sleep Medicine, Department of Medicine, The University of Saskatchewan, Saskatoon, SK, Canada. r.skomro@usask.ca
authors.forename: Robert P
authors.initials: RP
authors.lastname: Skomro
authors.forename: John
authors.initials: J
authors.lastname: Gjevre
authors.forename: John
authors.initials: J
authors.lastname: Reid
authors.forename: Brian
authors.initials: B
authors.lastname: McNab
authors.forename: Sunita
authors.initials: S
authors.lastname: Ghosh
authors.forename: Maryla
authors.initials: M
authors.lastname: Stiles
authors.forename: Ruzica
authors.initials: R
authors.lastname: Jokic
authors.forename: Heather
authors.initials: H
authors.lastname: Ward
authors.forename: David
authors.initials: D
authors.lastname: Cotton
mesh_terms: D000328:Adult; D045422:Continuous Positive Airway Pressure; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018670:Monitoring, Ambulatory; D017286:Polysomnography; D011788:Quality of Life; D012890:Sleep; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000628:therapy*; D016896:Treatment Outcome