Home unattended portable monitoring and automatic CPAP titration in patients with high risk for moderate to severe obstructive sleep apnea

摘要

BACKGROUND: Obstructive sleep apnea is a disorder characterized by recurrent obstruction of the upper airways during sleep. The high prevalence of this disease led to proposed new strategies based on the home evaluation and management of patients. OBJECTIVE: To compare home unattended portable monitoring and automatic CPAP titration with attended in-laboratory analysis, in a sample of patients with high risk for moderate to severe obstructive sleep apnea. METH-ODS: We enrolled 131 subjects, who were randomly divided into 2 groups: the home group (n 66) was diagnosed and titrated at home; the laboratory group (n 65) was analyzed in the sleep laboratory of our hospital. Diagnostic evaluations were carried out with portable monitoring at home, and with polysomnography in the sleep laboratory. Titration of CPAP was performed with the same automatic CPAP device in both groups. RESULTS: At the end of the study, 13 (19%) subjects had dropped out of the home group, and 9 (14%) of the laboratory group (P.50). There were no significant differences among groups in both baseline and with-CPAP values of apnea-hypopnea index, oxygen desaturation index, and total sleep time with SpO2 below 90%. In the home group, the therapeutic pressure values reached at the end of each unattended home titration night were similar. CONCLUSIONS: A home diagnosis and titration approach should be considered in a subset of patients with obstructive sleep apnea. A single unattended titration night is sufficient to determine the therapeutic pressure.