NEW ORLEANS — The running argument over home sleep testing versus overnight testing in a sleep lab may have been settled by research presented May 19 at the American Thoracic Society's 2010 International Conference. Or if not, it has at least given clinicians something more to think about.
Based on a new study, people who performed sleep testing at home with portable monitors showed similar improvements after three months of CPAP treatment in daytime function compared to patients who underwent overnight testing in a sleep center. In addition, the study found, patient compliance with the therapy over the first three months was similar in those with obstructive sleep apnea who had at-home versus in-lab testing.
According to Samuel T. Kuna, MD, chief of the pulmonary, critical care and sleep section at the Philadelphia VA Medical Center, OSA is common, dangerous and relatively easy to treat — but expensive to diagnose. "Currently, most patients with OSA need to perform overnight sleep testing (polysomnogram) in a sleep center," said Kuna, who led the research. "The result has been unacceptably long patient wait times and restricted access to care."
Kuna said that combined with the lesser expense of home testing, the equivalent results in terms of health-related outcomes suggest that portable devices could make in-lab testing a thing of the past for many OSA patients.
In the study, nearly 300 patients were randomly selected to undergo either standard in-laboratory sleep testing or at-home testing. Of the 223 patients who started CPAP therapy after evaluation, 185 completed three months of follow-up. The results showed those who had undergone at-home testing had improvements similar to those who had undergone in-lab diagnosis.
Average hours of daily use over the three-month period were also similar in the two groups.
"Proponents of in-laboratory testing argue that patients performing in-lab testing might have better outcomes than those performing home testing. For example, during in-lab testing, the patient spends a greater amount of time with a technologist who is able to educate the patient about OSA and CPAP and help the patient overcome any barriers to diagnosis and treatment that might arise during testing," said Kuna. "But our results did not find a difference between home versus in-lab testing in terms of clinical outcomes. The two management pathways appear to be equivalent in terms of patients' functional outcomes and ability to use CPAP treatment …
"Greater use of portable monitors will improve patient access to care and hopefully reduce medical care cost by replacing an expensive [in-lab polysomnography] with the less expensive home testing," Kuna said.
It is conservatively estimated that 4 percent of women and 9 percent of men in the United States have moderate to severe OSA, and that 80 percent of them remain undiagnosed and untreated, according to a summary of the research.
The study was conducted in collaboration with Dr. Charles Atwood at the VA Pittsburgh Healthcare System and the University of Pittsburgh.