title: Does home sleep testing impair continuous positive airway pressure adherence in patients with obstructive sleep apnea?
abstract: BACKGROUND
  The increasing recognition of obstructive sleep apnea (OSA) and demand for polysomnography has created a need for home sleep testing (HST) using unattended diagnostic and titration studies. Although these studies increase access to care and reduce cost, the limited interaction with sleep laboratories may negatively affect positive airway pressure (PAP) adherence. We sought to determine the difference in PAP use between HST and traditional in-laboratory studies.
  
  
  METHODS
  This observational cohort study included 210 patients with OSA classified into three equal groups. Following preestablished guidelines, group 1 underwent unattended, type III home diagnostic and unattended home auto-adjustable PAP (APAP) titrations; group 2 underwent in-laboratory, type I diagnostic and continuous PAP titration studies; group 3 underwent type I diagnostic and APAP titration studies. Group 1 was primarily managed and educated in a primary care clinic, whereas groups 2 and 3 received extensive education in an academic sleep medicine center. Objective measures of PAP use during the first 4 to 6 weeks of therapy were compared between groups.
  
  
  RESULTS
  Type of study and location of care did not affect PAP adherence. PAP was used for 70%, 73%, and 72% of nights in groups 1, 2, and 3, respectively (P = .94). Mean hours of nightly use (4.4 ± 2.0 h, 4.7 ± 1.5 h, and 4.6 ± 1.5 h; P = .98) was also similar. Regular use was observed in 54%, 51%, and 50% of subjects (P = .84). Discontinuation rates were similar between groups.
  
  
  CONCLUSIONS
  PAP usage did not differ between those undergoing HST vs in-laboratory studies. HST offers a more accessible and cost-effective alternative without compromising therapeutic adherence.
authors.affiliation: Department of Family Medicine, DeWitt Army Community Hospital, Fort Belvoir, VA; Department of Family Medicine, Uniformed Services University, Bethesda, MD. Electronic address: Christine.Lettieri@us.army.mil.
authors.forename: Christine F
authors.initials: CF
authors.lastname: Lettieri
authors.affiliation: Department of Pulmonary, Critical Care, and Sleep Medicine, Walter Reed Army Medical Center, Washington DC; Department of Medicine, Uniformed Services University, Bethesda, MD.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Lettieri
authors.affiliation: Department of Pulmonary, Critical Care, and Sleep Medicine, Walter Reed Army Medical Center, Washington DC.
authors.forename: Kevin
authors.initials: K
authors.lastname: Carter
mesh_terms: D045422:Continuous Positive Airway Pressure; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D017286:Polysomnography / Q000379:methods*; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000503:physiopathology; D016896:Treatment Outcome