Effect of an ambulatory diagnostic and treatment programme in patients with sleep apnoea

Abstract

The aim of this study to evaluate the efficacy of a home-based programme on clinical response, continuous positive airway pressure (CPAP) compliance and cost in a population of high pre-test probability of suffering obstructive sleep apnoea syndrome (OSAS).Patients were randomised into the following three groups. Group A: home respiratory polygraphy (RP) and home follow-up; group B: hospital polysomnography and hospital followup; and group C: home RP and hospital follow-up. Evaluation during 6 months included Epworth Sleepiness Scale (ESS), Functional Outcomes Sleep Questionnaire (FOSQ), and daily activity and symptom questionnaires. Compliance was assessed by memory cards (group A) and using an hourly counter (groups B and C).66 patients were included (22 per branch), 83% were males, aged mean¡SD 52¡10 yrs, body mass index 34¡7kg?m -2 , apnoea/hypopnoea index 43¡20 h -1 , CPAP pressure 8¡2 cmH 2 O, with no between-group differences. Clinical response showed an ESS of mean¡SD 15¡3 to 6¡4, a FOSQ of 16¡3 to 18¡2, symptoms of 43¡7 to 25¡7, and activity of 37¡11 to 25¡8. At the end of the study, compliance was: group A 73%, group B 68% and group C 57%. The cost per patient was: group A J590¡43, group B J894¡11 and group C J644¡93 (p,0.001).In conclusion, patients with a high initial probability of having OSAS can be diagnosed and treated in a home setting, with a high level of CPAP compliance and lower cost than using either a hospital-based approach or home RP/hospital follow-up.

Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline

“…[83][84][85][107][108][109][110] Four of these RCTs were determined to be most relevant to clinical practice, as they did not require oximetry testing as a criterion for inclusion and used conventional methods for determination of PAP pressures (i.e., APAP or attended titration). [83][84][85]110 This subset of studies will be referred to as "RCTs most generalizable to clinical practice" for the remainder of this discussion section.…”

“…[83][84][85][107][108][109][110] The meta-analysis showed a clinically and statistically insignificant difference of 0.38 points (95% CI: −1.07 to 0.32 points) greater improvement in patients randomized to the HSAT pathway versus the attended PSG pathway. This difference indicates that subjective sleepiness is similarly improved in patients who initiate PAP treatment based on diagnosis using either HSAT or PSG.…”

“…84,85,[107][108][109][110] Meta-analysis demonstrated differences in pooled effects between pathways that were not significant (see supplemental material, Figure S19 through Figure S23, and Table S58). The quality of evidence ranged from moderate to high based on the measure used to assess QOL.…”

“…[83][84][85][108][109][110] When determining adherence by number of nights with greater than 4 hours of use, meta-analysis of five RCTs found a clinically insignificant trend towards increased CPAP adherence in the HSAT arm versus the PSG arm (see supplemental material, Figure S25). [83][84][85]107,110 The quality of evidence for CPAP adherence was moderate to high across different AHI cutoffs after being downgraded due to imprecision. The TF determined that the overall quality of evidence across AHI cutoffs was high.…”

Diagnostic accuracy of level 3 portable sleep tests versus level 1 polysomnography for sleep-disordered breathing: a systematic review and meta-analysis

“…None of the studies found significant differences in disease management parameters. [77][78][79]92,93,99,102,103 In most of the studies, patients underwent both level 1 and level 3 tests to avoid the risk of internal bias due to differences between study groups. In all of the simultaneous studies, level 3 tests were scored manually by the same technician who scored the level 1 test, which may have resulted in observer bias.…”