title: Physician Decision Making and Clinical Outcomes With Laboratory Polysomnography or Limited-Channel Sleep Studies for Obstructive Sleep Apnea: A Randomized Trial.
abstract: BACKGROUND
  The clinical utility of limited-channel sleep studies (which are increasingly conducted at home) versus laboratory polysomnography (PSG) for diagnosing obstructive sleep apnea (OSA) is unclear.
  
  
  OBJECTIVE
  To compare patient outcomes after PSG versus limited-channel studies.
  
  
  METHODS
  Multicenter, randomized, noninferiority study. (Australian New Zealand Clinical Trials Registry: ACTRN12611000926932).
  
  
  METHODS
  7 academic sleep centers.
  
  
  METHODS
  Patients (n = 406) aged 25 to 80 years with suspected OSA.
  
  
  METHODS
  Sleep study information disclosed to sleep physicians comprised level 1 (L1) PSG data (n = 135); level 3 (L3), which included airflow, thoracoabdominal bands, body position, electrocardiography, and oxygen saturation (n = 136); or level 4 (L4), which included oxygen saturation and heart rate (n = 135).
  
  
  METHODS
  The primary outcome was change in Functional Outcomes of Sleep Questionnaire (FOSQ) score at 4 months. Secondary outcomes included the Epworth Sleepiness Scale (ESS), the Sleep Apnea Symptoms Questionnaire (SASQ), continuous positive airway pressure (CPAP) compliance, and physician decision making.
  
  
  RESULTS
  Change in FOSQ score was not inferior for L3 (mean difference [MD], 0.01 [95% CI, -0.47 to 0.49; P = 0.96]) or L4 (MD, -0.46 [CI, -0.94 to 0.02; P = 0.058]) versus L1 (noninferiority margin [NIM], -1.0). Compared with L1, change in ESS score was not inferior for L3 (MD, 0.08 [CI, -0.98 to 1.13; P = 0.89]) but was inconclusive for L4 (MD, 1.30 [CI, 0.26 to 2.35; P = 0.015]) (NIM, 2.0). For L4 versus L1, there was less improvement in SASQ score (-17.8 vs. -24.7; P = 0.018), less CPAP use (4.5 vs. 5.3 hours per night; P = 0.04), and lower physician diagnostic confidence (P = 0.003).
  
  
  CONCLUSIONS
  Limited-channel studies were simulated by extracting laboratory PSG data and were not done in the home.
  
  
  CONCLUSIONS
  The results support manually scored L3 testing in routine practice. Poorer outcomes with L4 testing may relate, in part, to reduced physician confidence.
  
  
  BACKGROUND
  National Health and Medical Research Council and Repat Foundation.
authors.affiliation: From Flinders University, Repatriation General Hospital, and Royal Adelaide Hospital, Adelaide, South Australia; Monash Health, Monash University, and The Alfred Hospital, Melbourne, Victoria; Sir Charles Gairdner Hospital, Perth, Western Australia; Royal Prince Alfred Hospital & Woolcock Institute of Medical Research, Sydney, New South Wales; and Gosford Hospital, Gosford, New South Wales, Australia.
authors.forename: Ching Li
authors.initials: CL
authors.lastname: Chai-Coetzer
authors.affiliation: From Flinders University, Repatriation General Hospital, and Royal Adelaide Hospital, Adelaide, South Australia; Monash Health, Monash University, and The Alfred Hospital, Melbourne, Victoria; Sir Charles Gairdner Hospital, Perth, Western Australia; Royal Prince Alfred Hospital & Woolcock Institute of Medical Research, Sydney, New South Wales; and Gosford Hospital, Gosford, New South Wales, Australia.
authors.forename: Nick A
authors.initials: NA
authors.lastname: Antic
authors.affiliation: From Flinders University, Repatriation General Hospital, and Royal Adelaide Hospital, Adelaide, South Australia; Monash Health, Monash University, and The Alfred Hospital, Melbourne, Victoria; Sir Charles Gairdner Hospital, Perth, Western Australia; Royal Prince Alfred Hospital & Woolcock Institute of Medical Research, Sydney, New South Wales; and Gosford Hospital, Gosford, New South Wales, Australia.
authors.forename: Garun S
authors.initials: GS
authors.lastname: Hamilton
authors.affiliation: From Flinders University, Repatriation General Hospital, and Royal Adelaide Hospital, Adelaide, South Australia; Monash Health, Monash University, and The Alfred Hospital, Melbourne, Victoria; Sir Charles Gairdner Hospital, Perth, Western Australia; Royal Prince Alfred Hospital & Woolcock Institute of Medical Research, Sydney, New South Wales; and Gosford Hospital, Gosford, New South Wales, Australia.
authors.forename: Nigel
authors.initials: N
authors.lastname: McArdle
authors.affiliation: From Flinders University, Repatriation General Hospital, and Royal Adelaide Hospital, Adelaide, South Australia; Monash Health, Monash University, and The Alfred Hospital, Melbourne, Victoria; Sir Charles Gairdner Hospital, Perth, Western Australia; Royal Prince Alfred Hospital & Woolcock Institute of Medical Research, Sydney, New South Wales; and Gosford Hospital, Gosford, New South Wales, Australia.
authors.forename: Keith
authors.initials: K
authors.lastname: Wong
authors.affiliation: From Flinders University, Repatriation General Hospital, and Royal Adelaide Hospital, Adelaide, South Australia; Monash Health, Monash University, and The Alfred Hospital, Melbourne, Victoria; Sir Charles Gairdner Hospital, Perth, Western Australia; Royal Prince Alfred Hospital & Woolcock Institute of Medical Research, Sydney, New South Wales; and Gosford Hospital, Gosford, New South Wales, Australia.
authors.forename: Brendon J
authors.initials: BJ
authors.lastname: Yee
authors.affiliation: From Flinders University, Repatriation General Hospital, and Royal Adelaide Hospital, Adelaide, South Australia; Monash Health, Monash University, and The Alfred Hospital, Melbourne, Victoria; Sir Charles Gairdner Hospital, Perth, Western Australia; Royal Prince Alfred Hospital & Woolcock Institute of Medical Research, Sydney, New South Wales; and Gosford Hospital, Gosford, New South Wales, Australia.
authors.forename: Aeneas
authors.initials: A
authors.lastname: Yeo
authors.affiliation: From Flinders University, Repatriation General Hospital, and Royal Adelaide Hospital, Adelaide, South Australia; Monash Health, Monash University, and The Alfred Hospital, Melbourne, Victoria; Sir Charles Gairdner Hospital, Perth, Western Australia; Royal Prince Alfred Hospital & Woolcock Institute of Medical Research, Sydney, New South Wales; and Gosford Hospital, Gosford, New South Wales, Australia.
authors.forename: Rajeev
authors.initials: R
authors.lastname: Ratnavadivel
authors.affiliation: From Flinders University, Repatriation General Hospital, and Royal Adelaide Hospital, Adelaide, South Australia; Monash Health, Monash University, and The Alfred Hospital, Melbourne, Victoria; Sir Charles Gairdner Hospital, Perth, Western Australia; Royal Prince Alfred Hospital & Woolcock Institute of Medical Research, Sydney, New South Wales; and Gosford Hospital, Gosford, New South Wales, Australia.
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Naughton
authors.affiliation: From Flinders University, Repatriation General Hospital, and Royal Adelaide Hospital, Adelaide, South Australia; Monash Health, Monash University, and The Alfred Hospital, Melbourne, Victoria; Sir Charles Gairdner Hospital, Perth, Western Australia; Royal Prince Alfred Hospital & Woolcock Institute of Medical Research, Sydney, New South Wales; and Gosford Hospital, Gosford, New South Wales, Australia.
authors.forename: Teanau
authors.initials: T
authors.lastname: Roebuck
authors.affiliation: From Flinders University, Repatriation General Hospital, and Royal Adelaide Hospital, Adelaide, South Australia; Monash Health, Monash University, and The Alfred Hospital, Melbourne, Victoria; Sir Charles Gairdner Hospital, Perth, Western Australia; Royal Prince Alfred Hospital & Woolcock Institute of Medical Research, Sydney, New South Wales; and Gosford Hospital, Gosford, New South Wales, Australia.
authors.forename: Richard
authors.initials: R
authors.lastname: Woodman
authors.affiliation: From Flinders University, Repatriation General Hospital, and Royal Adelaide Hospital, Adelaide, South Australia; Monash Health, Monash University, and The Alfred Hospital, Melbourne, Victoria; Sir Charles Gairdner Hospital, Perth, Western Australia; Royal Prince Alfred Hospital & Woolcock Institute of Medical Research, Sydney, New South Wales; and Gosford Hospital, Gosford, New South Wales, Australia.
authors.forename: R Doug
authors.initials: RD
authors.lastname: McEvoy
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000066491:Clinical Decision-Making; D045422:Continuous Positive Airway Pressure; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018670:Monitoring, Ambulatory / Q000379:methods*; D017060:Patient Satisfaction; D017286:Polysomnography / Q000379:methods*; D011788:Quality of Life; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000628:therapy; D011795:Surveys and Questionnaires