title: A randomized controlled trial of an ambulatory approach versus the hospital-based approach in managing suspected obstructive sleep apnea syndrome.
abstract: Comparisons of home-based versus hospital-based approach in managing patients with suspected obstructive sleep apnoea syndrome(OSAS). A prospective, controlled CPAP parallel study of new referrals with suspected OSAS randomized into group A) home-based or B) hospital-based approach. Following detection of AHI ≥ 15/hr by Embletta sleep study (group A) or polysomnography (group B), patients received CPAP for 3 months after an overnight autoCPAP titration at home or in hospital respectively. Modified intention-to-treat analysis of those with AHI ≥ 15/hr on CPAP (n = 86 vs 86) showed no difference in Epworth sleepiness score, the primary endpoint, but greater improvement in Sleep-Apnoea-Quality-of-Life-Index[difference 0.3,(95%CI 0.02, 0.6), p = 0.033] at 3 months in group A. The mean costs for the patients in group A and group B were HK$8479(989) and HK$22,248(2407) respectively. The mean difference between groups was HK$-13,769(USD 1770 equivalent) per patient with 95% CI. (-14324, -13213), p < 0.001. The waiting time of patients with AHI ≥ 15/hr who were started on CPAP treatment from the first clinic consultation to the diagnostic sleep test, autoCPAP titration, and CPAP treatment was 189.6, 148.8 and 145.0 days shorter in group A than group B respectively. Home-based approach is non-inferior to hospital-based approach in managing patients with suspected OSAS, with shorter waiting time, and substantial cost savings.
authors.affiliation: Dept of Medicine &Therapeutics, The Chinese University of Hong Kong, Hong Kong.|SH Ho Sleep Apnoea Management Center, The Chinese University of Hong Kong, Hong Kong.
authors.forename: David S
authors.initials: DS
authors.lastname: Hui
authors.affiliation: Dept of Medicine &Therapeutics, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Susanna S
authors.initials: SS
authors.lastname: Ng
authors.affiliation: Dept of Medicine &Therapeutics, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Kin-Wang
authors.initials: KW
authors.lastname: To
authors.affiliation: Dept of Medicine &Therapeutics, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Fanny W
authors.initials: FW
authors.lastname: Ko
authors.affiliation: Dept of Medicine &Therapeutics, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Jenny
authors.initials: J
authors.lastname: Ngai
authors.affiliation: Dept of Medicine &Therapeutics, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Ken K P
authors.initials: KK
authors.lastname: Chan
authors.affiliation: Dept of Medicine &Therapeutics, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Wing-Ho
authors.initials: WH
authors.lastname: Yip
authors.affiliation: Dept of Medicine &Therapeutics, The Chinese University of Hong Kong, Hong Kong.|SH Ho Sleep Apnoea Management Center, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Tat-On
authors.initials: TO
authors.lastname: Chan
authors.affiliation: Dept of Medicine &Therapeutics, The Chinese University of Hong Kong, Hong Kong.|SH Ho Sleep Apnoea Management Center, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Karen
authors.initials: K
authors.lastname: Yiu
authors.affiliation: Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore.
authors.forename: Wilson W S
authors.initials: WW
authors.lastname: Tam
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000191:economics*; D045422:Continuous Positive Airway Pressure / Q000379:methods; D004469:Economics, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017286:Polysomnography / Q000379:methods; D020181:Sleep Apnea, Obstructive / Q000191:economics / Q000453:epidemiology* / Q000628:therapy*