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.
