Both home and lab groups also had significant improvements on the Epworth Sleepiness Scale (–2.6 and –2.9, respectively), the mental health component of the 12-item Short Form Health Survey (+2.5 and +3.0), and the Center for Epidemiologic Studies–Depression scale (–1.4 and –2.2). Neither group improved significantly on the psychovigilance task or the physical health component of the 12-item Short Form Health Survey.
When it came to adherence, which was monitored with smart cards, the mean adjusted number of CPAP hours daily was 3.42 in the home group and 2.99 in the lab group, a difference that was not significant. Cost-effectiveness analyses are still ongoing.
"We concluded that the functional improvement with CPAP for sleep apnea is not worse when treated in the home setting vs. the sleep lab," Dr. Atwood said. "We believe that the implication is that home-based sleep apnea diagnosis and initiation of CPAP therapy is an effective way to treat sleep apnea."
Despite all of the accumulating favorable findings for home testing, Dr. Atwood was skeptical that it will entirely replace laboratory polysomnography.
"Home sleep apnea testing is part of the future, but it’s unlikely to be the whole future," he contended. "The way to think about home sleep apnea testing now is not ‘either/or,’ but really to begin to integrate home sleep testing with full polysomnography in a clinically rational way."
Dr. Atwood reported that he received research support from Embla, Resmed, and Respironics, and is a consultant to Embla and Itamar Medical, all of which manufacture testing and treatment devices for sleep disorders.