title: Home-based diagnosis of obstructive sleep apnea in an urban population.
abstract: OBJECTIVE
  Home-based diagnosis of obstructive sleep apnea (OSA) with portable monitoring (PM) is increasingly utilized, but remains understudied in underserved and minority populations. We tested the feasibility of home PM in an urban population at risk for OSA compared to in-laboratory polysomnography (PSG) and examined patient preference with respect to home PM versus PSG.
  
  
  METHODS
  Randomized crossover study of home PM (WatchPAT200) and in-laboratory simultaneous PSG and PM in 75 urban African Americans with high pre-test probability of OSA, identified with the Berlin questionnaire.
  
  
  RESULTS
  Fifty-seven of 75 participants were women, average age 45 ± 11 years (mean ± SD), 35% with ≤ high school education, and 76% with annual household income < $50,000. Technical failure rates were 5.3% for home vs. 3.1% for in-laboratory PM. There was good agreement between apnea hypopnea index on PSG; AHIPSG and AHI on home PM (mean ± 2 SD of the differences = 0.64 ± 46.5 and intraclass correlation coefficient; ICC = 0.73). The areas under the curve for the receiver-operator characteristic curves for home PM were 0.90 for AHIPSG ≥ 5, 0.95 for AHIPSG ≥ 10, and 0.92 for AHIPSG ≥ 15. 62/75 (82%) participants preferred home over in-laboratory testing.
  
  
  CONCLUSIONS
  Home PM for diagnosis of OSA in a high risk urban population is feasible, accurate, and preferred by patients. As home PM may improve access to care, the cost-effectiveness of this diagnostic strategy for OSA should be examined in underserved urban and rural populations.
  
  
  BACKGROUND
  ClinicalTrials.gov, identifier: NCT01997723.
authors.affiliation: Center for Narcolepsy, Sleep and Health Research, University of Illinois at Chicago, Chicago, IL;
authors.forename: Natasha
authors.initials: N
authors.lastname: Garg
authors.affiliation: Population Health Sciences, Section of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois at Chicago, Chicago, IL.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Rolle
authors.affiliation: Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago, Chicago, IL;
authors.forename: Todd A
authors.initials: TA
authors.lastname: Lee
authors.affiliation: Section of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois at Chicago, Chicago, IL; ; Center for Narcolepsy, Sleep and Health Research, University of Illinois at Chicago, Chicago, IL;
authors.forename: Bharati
authors.initials: B
authors.lastname: Prasad
mesh_terms: D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D017286:Polysomnography; D012648:Self Care / Q000379:methods*; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis*; D014505:Urban Population
keywords: OSA; comparative effectiveness research; portable monitoring