(Ivanhoe Newswire) — Patients with suspected obstructive sleep apnea (OSA)
may be spared an expensive, uncomfortable night at a sleep center to monitor
their sleep-disordered breathing.
Researchers have found that patients who performed sleep testing in their homes
with portable monitors showed similar improvements in daytime function after
three months of treatment with continuous positive airway pressure (CPAP) to
patients who underwent overnight testing in a sleep center.
Furthermore, patient adherence to CPAP over the first three months of treatment
was similar in patients with OSA who received in-home versus in-lab testing.
Obstructive sleep apnea is common, dangerous, and relatively easy to treat, but
expensive to diagnose. "These findings represent a possible turning point for
both patients with sleep-disordered breathing and the clinicians who treat
them," senior researcher Samuel T. Kuna, M.D., Chief of the pulmonary, critical
care and sleep section at the Philadelphia VA Medical Center, was quoted as
saying. "One of the biggest and most insurmountable barriers to treatment is the
need for overnight testing in a sleep laboratory. Our research suggests that
this may no longer be a mandatory for diagnosis."
It
is estimated that 4 percent of women and 9 percent of men in the U.A. have
moderate to severe OSA and that 80 percent of these individuals are undiagnosed
and untreated. Patients with untreated OSA are at increased risk for traffic
accidents, hypertension and cardiovascular disease.
"Currently, most patients with OSA need to perform overnight sleep testing in a
sleep center," explained Dr. Kuna. "The result has been unacceptably long
patient wait times and restricted access to care."
The researchers studied nearly 300 patients who underwent either in-laboratory
sleep-testing or at-home testing. Of the 223 patients who started CPAP treatment
after evaluation, 185 completed three months of follow-up. Those who had
undergone at-home testing showed improvements after three months of CPAP
treatment similar to those who had undergone in-lab diagnosis.
"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 Dr. 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."
SOURCE: Presented at the American Thoracic Society (ATS) 2010 International
Conference, New Orleans, May 18, 2010.