• Sleep · Nov 2006

    Randomized Controlled Trial Comparative Study

    Comparison of CPAP titration at home or the sleep laboratory in the sleep apnea hypopnea syndrome.

    • Melanie D Cross, Marjorie Vennelle, Heather M Engleman, Sandra White, Thomas W Mackay, Sarah Twaddle, and Neil J Douglas.
    • Department of Sleep Medicine, Royal Infirmary of Edinburgh, Scotland, UK.
    • Sleep. 2006 Nov 1; 29 (11): 1451-5.

    Study ObjectivesContinuous positive airway pressure (CPAP) for the treatment of obstructive sleep apnea hypopnea syndrome (OSAHS) is conventionally started after in-laboratory overnight titration. This use of sleep laboratory space is both costly and limits access for diagnostic studies. This study aimed to evaluate whether automated CPAP titration in the home produced patient outcomes equal to those following laboratory-based automated CPAP titration. The main outcomes were Epworth Sleepiness Scale score, objective daytime sleepiness (Oxford SLEep Resistance test or OSLER test), and CPAP use; we also performed quality-of-life questionnaires: Functional Outcomes of Sleep Questionnaire and SF-36.DesignProspective, randomized, single-blind, parallel-group, controlled trialSettingRegional sleep center and patients' homes.PatientsTwo hundred CPAP-naïve patients with OSAHS requiring CPAP treatment.InterventionsOne hundred patients were randomly assigned to a standard 1-night in-hospital CPAP titration and 100 to 3 nights' home CPAP titration and then issued with fixed pressure CPAP. Data were analyzed on an intention-to-treat basis.Measurements And ResultsThe patient groups did not differ at baseline. The CPAP pressures defined at titration (mean+/- SEM: 10.6+/-0.2, 10.4+/-0.2 cm H20, p = .19), number of mask leaks, and initial acceptance rates were similar in the sleep-laboratory and home-titrated groups. At 3-month follow-up, there was no significant difference in CPAP use (mean+/-SEM: 4.39+/-0.25, 4.38+/-0.25 h/night; p > .9), Epworth Sleepiness Scale score (9.5+/-0.5, 8.5+/-0.5, p = .14), OSLER, Functional Outcomes of Sleep Questionnaire, or SF-36 between the sleep-laboratory and home-titrated groups.ConclusionsHome-based automated CPAP titration is as effective as automatic in-laboratory titrations in initiating treatment for OSAHS.

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