A Multi site Randomized Trial of Portable Sleep Studies and Positive Airway Pressure Autotitration Versus Laboratory-Based Polysomnography the Diagnosis and Treatment of OSA: The Home-pap Study

This randomized controlled clinical trial demonstrates that in the hands of sleep medicine specialists an integrated home-based portable monitoring strategy for both diagnosis and treatment of patients with moderate to severe OSA is not inferior to

a laboratory-based strategy. The home-based strategy appears equivalent in terms of outcomes important to patients: acceptance of therapy, time to treatment, reduced hypersomnolence, improved functional outcomes (both generic and disease-specific),

and treatment characteristics. Despite use of standardized approaches and strong support for enhancing adherence for all study participants, adherence was only moderately high, although it was significantly greater at 3 month in the home-based arm in comparison with to the laboratory arm.

The findings in this study are consistent with 4 other similarly conducted studies 16-19 in patients who were (1) evaluated by physicians trained in sleep medicine, (2) at significant risk for moderate to severe OSA, and (3) excluded if they had co-morbid medical conditions likely to degrade the accuracy of portable monitoring.20 Our study

is unique in that it included patients and sleep specialists from multiple sleep centers across the United States with a substantial proportion of female participants (35%), and thus may provide data that can be more readily generalized to U.S. sleep medicine practices. Our findings of non-inferiority are also similar to those found in a recent study a predominantly male sample from 2 Veterans Affairs (VA) hospital Sites.

Sleep Rosen 2012.pdf

Download PDF • 598KB