Home-based OSA management time-saving, noninferior to hospital-based approach
Ambulatory or home-based management of suspected obstructive sleep apnoea (OSA) was noninferior to the conventional hospital-based approach, with the advantage of a shorter waiting time, according to a study.
In this prospective analysis, 316 patients aged 18–80 years with suspected OSA were randomized to home-based (Embletta sleep study, n=157) or hospital-based (polysomnography [PSG], n=159) management. Eighty-six participants from each group had an apnoea-hypopnoea index (AHI) of ≥15/hr, 131 (n=62 and 69 from the home and hospital groups, respectively) of whom underwent continuous positive airway pressure (CPAP) therapy and completed the 3-month follow-up.
In the modified intention-to-treat analysis, greater improvement in Sleep-Apnoea-Quality-of-Life-Index at 3 months was observed in the home vs hospital group (difference, 0.3, 95 percent confidence interval, 0.02–0.6; p=0.033). [Sci Rep 2017;8:45901]
Waiting time for sleep tests and treatment was significantly shorter in the home vs hospital group from the first clinic consultation to the diagnostic sleep test (59.3 vs 248.9 days), autoCPAP titration (117.3 vs 266.1 days), and CPAP treatment (154.7 vs 299.7 days; p<0.001 for all).
The longer waiting time in the hospital group could be attributed to the limited number of designated beds for sleep medicine service, noted the researchers.
“It is important to shorten the waiting time for sleep investigation and treatment especially for those with a high clinical probability of OSA, as many studies have shown that untreated OSA is associated with increased risks of hypertension, platelet activation, diastolic dysfunction, mortality, sudden death, and stroke,” they said.
The researchers cautioned that the use of the Embletta device could have underestimated AHI by recording only the number of obstructive events/hour of recording instead of actual sleep time.
However, given the higher costs and longer waiting time associated with PSG, the increasing demand for immediate access to testing, and the flexibility associated with home-based treatment, the American Academy of Sleep Medicine validated portable monitoring devices as suitable alternatives for the management of OSA, noted the researchers.
“[Overall, our] study findings add more strength to the growing literature that the ambulatory approach is an alternative strategy in managing clinic patients with suspected OSA,” said the researchers.