title: The impact of sleep consultation prior to a diagnostic polysomnogram on continuous positive airway pressure adherence.
abstract: BACKGROUND
  Polysomnograms (PSGs) are routinely ordered by nonsleep specialists. However, it is unknown whether a sleep specialist consultation prior to a diagnostic PSG influences adherence to continuous positive airway pressure (CPAP) therapy.
  
  
  METHODS
  This study was done at the University of Chicago Sleep Disorders Center and included 403 patients with obstructive sleep apnea who had CPAP adherence data available. CPAP was set up at home, and objective adherence was remotely monitored during the first 30 days of therapy. Physicians who ordered PSGs were divided into two groups: sleep specialists and nonsleep specialists.
  
  
  RESULTS
  Patients were aged 52.5 ± 14 years, 47% were men, and 54% were African American. Mean daily CPAP use was greater in patients who were referred by sleep specialists (n = 105, 279 ± 179 min/d) than in patients referred by nonsleep specialists (n = 298, 219 ± 152 min/d, P = .005). In the linear regression model adjusting for several covariates, only two predictors were significantly associated with CPAP adherence. A sleep specialist consultation prior to the diagnostic PSG was associated with 58.2 min more per day (P = .002), and African American race was associated with 56.0 min less per day (P = .002) of CPAP use.
  
  
  CONCLUSIONS
  In this cohort study, CPAP adherence was significantly higher with a sleep specialist consultation prior to the diagnostic PSG. In addition, African American race was associated with worse adherence to therapy. A better understanding of predictors of CPAP adherence may be useful in identifying patients who may benefit from a sleep specialist consultation prior to ordering a diagnostic PSG.
authors.affiliation: Sleep Disorders Center, Section of Pulmonary and Critical Care, Department of Medicine, University of Chicago, Chicago, IL.
authors.forename: Sushmita
authors.initials: S
authors.lastname: Pamidi
authors.affiliation: Sleep Disorders Center, Section of Pulmonary and Critical Care, Department of Medicine, University of Chicago, Chicago, IL.
authors.forename: Kristen L
authors.initials: KL
authors.lastname: Knutson
authors.affiliation: Sleep Disorders Center, Section of Pulmonary and Critical Care, Department of Medicine, University of Chicago, Chicago, IL.
authors.forename: Farbod
authors.initials: F
authors.lastname: Ghods
authors.affiliation: Sleep Disorders Center, Section of Pulmonary and Critical Care, Department of Medicine, University of Chicago, Chicago, IL. Electronic address: bmokhles@medicine.bsd.uchicago.edu.
authors.forename: Babak
authors.initials: B
authors.lastname: Mokhlesi
mesh_terms: D045422:Continuous Positive Airway Pressure / Q000379:methods* / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D017286:Polysomnography / Q000523:psychology*; D012017:Referral and Consultation; D012189:Retrospective Studies; D012890:Sleep / Q000502:physiology*; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy; D016896:Treatment Outcome