Home-based diagnosis of obstructive sleep apnea in an urban population.
STUDY OBJECTIVES
Home-based diagnosis of obstructive sleep apnea (OSA) with portable monitoring (PM) is increasingly utilized, but remains understudied in underserved and minority populations. We tested the feasibility of home PM in an urban population at risk for OSA compared to in-laboratory polysomnography (PSG) and examined patient preference with respect to home PM versus PSG.


METHODS
Randomized crossover study of home PM (WatchPAT200) and in-laboratory simultaneous PSG and PM in 75 urban African Americans with high pre-test probability of OSA, identified with the Berlin questionnaire.


RESULTS
Fifty-seven of 75 participants were women, average age 45 ± 11 years (mean ± SD), 35% with ≤ high school education, and 76% with annual household income < $50,000. Technical failure rates were 5.3% for home vs. 3.1% for in-laboratory PM. There was good agreement between apnea hypopnea index on PSG; AHIPSG and AHI on home PM (mean ± 2 SD of the differences = 0.64 ± 46.5 and intraclass correlation coefficient; ICC = 0.73). The areas under the curve for the receiver-operator characteristic curves for home PM were 0.90 for AHIPSG ≥ 5, 0.95 for AHIPSG ≥ 10, and 0.92 for AHIPSG ≥ 15. 62/75 (82%) participants preferred home over in-laboratory testing.


CONCLUSIONS
Home PM for diagnosis of OSA in a high risk urban population is feasible, accurate, and preferred by patients. As home PM may improve access to care, the cost-effectiveness of this diagnostic strategy for OSA should be examined in underserved urban and rural populations.


CLINICAL TRIALS REGISTRATION
ClinicalTrials.gov, identifier: NCT01997723.
['Garg|Natasha|N|', 'Rolle|Andrew J|AJ|', 'Lee|Todd A|TA|', 'Prasad|Bharati|B|']
D018592:Cross-Over Studies D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D008991:Monitoring, Physiologic D017286:Polysomnography D012648:Self Care D020181:Sleep Apnea, Obstructive D014505:Urban Population
OSA portable monitoring comparative effectiveness research