Home and lab sleep study data may be similar for use in management of obstructive sleep apnea

1. Patient outcomes for management of obstructive sleep apnea (OSA) using manually scored cardiorespiratory data or oximetry and heart rate data were not clinically inferior to management using laboratory-based polysomnography (PSG).

2. However, secondary outcomes appeared to be worse for management using only oximetry and heart rate data, so caution may be necessary when using solely this data for OSA management.

Evidence Rating Level: 1 (Excellent) 

Study Rundown: Due to the prevalence of OSA, demand has grown markedly for diagnostic sleep services. PSG, the gold standard for evaluating OSA, requires a great deal of labor, time, and expenses. Therefore, there has been growing interest in the use of limited-channel sleep studies which may record less data than lab-based PSG but can be conducted at home. In this randomized control trial (RCT), the authors conducted an intention-to-treat (ITT) study in sleep clinic patients being examined for suspected OSA. The authors sought to compare physician decision making and patient outcomes after PSG versus limited channel testing. The authors found that patients were diagnosed with moderate or severe OSA in similar proportions and were given similar treatment recommendations for all study groups. These results suggest that certain data for managing OSA can be acquired at home.

Strengths of this study compared to previous studies include longer follow-up and inclusion of patients who were representative of the general sleep clinic population being evaluated for suspected OSA. In addition, this study is the first RCT that the authors know of to directly compare patient outcomes and physician decision making for multiple levels of sleep study testing. A limitation of this study is that the limited-channel studies were not conducted in the home and were simulated through extraction of data from applicable laboratory data.

Click to read the study, published today in Annals of Internal Medicine

Click to read an accompanying editorial in Annals of Internal Medicine

Relevant Reading: Comparison between home and hospital set-up for unattended home-based polysomnography: a prospective randomized study

In-Depth [ randomized controlled trial]: In this RCT at 7 academic sleep centers, 406 patients from 25 to 80 years of age with suspected OSA were separated into groups that corresponded to the sleep study data that treating physicians would receive: full polysomnographic data (level 1 [L1]), cardiorespiratory data only (L3), or oximetry and heart rate data only (L4). Researchers found that moderate to severe OSA was found in a similar proportion in all groups, but mild OSA was more frequently diagnosed in the L3 and L4 groups. Non-respiratory sleep disorders were more frequently diagnosed in the L1 group. The primary patient outcome was change in the Functional Outcomes of Sleep Questionnaire (FOSQ) score. Secondary outcomes included the Epworth Sleepiness Scale (ESS) and the Sleep Apnea Symptoms Questionnaire (SASQ). For L3 (mean difference [MD], 0.01 [95% CI, –0.46 to 0.49; p = 0.96]) or L4 (MD, –0.46 [CI, –0.94 to 0.02; p = 0.058]), change in FOSQ score was not inferior compared to L1 (noninferiority margin [NIM], –1.0). For change in ESS score compared to L1, L3 was not inferior but L4 was inconclusive (NIM, 2.0). Compared to L1, L4 had decreased physician diagnostic confidence (p = 0.003) and less improvement in SASQ score.

Image: PD

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