Home-based diagnosis of obstructive sleep apnea in an urban population

Abstract

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.

Keywords: OSA; comparative effectiveness research; portable monitoring.

Figures

Figure 1. Research Protocol

Figure 2. Bland Altman Plot, Agreement of Home PM with PSG

PM, portable monitoring; AHIPM, apnea hypopnea index on PM; PSG, polysomnography; AHIPSG, apnea hyponea index on PSG; red line indicates mean difference; green lines indicate limits of agreement (2 x standard deviation).

Figure 3. Receiver operating characteristics

Receiver operating characteristic curves for home portable monitoring vs. polysomnography.

Figure 4. Home and Laboratory PM vs. PSG

PM, portable monitoring; Lab, in-laboratory; PSG, polysomnography; AUC, area under the curve.