Home testing & CPAP titration was fine for most vets with OSA

Kuna et al randomized 296 veterans with suspected obstructive sleep apnea (OSA) to home sleep testing with a type 3 portable monitor followed by auto-titrating CPAP, or in-lab polysomnography and CPAP titration. After 3 months of CPAP treatment (in the 260 or 88% overall who did have OSA), surveyed functional outcomes were identical between groups, and adherence trended higher (~3.5 hours/night) in the home-only group. Notably, 35 of 143 (25%) randomized to the home-only group got in-lab PSG after a negative or poor quality home test; 27 of those 35 were shown to have OSA. (They were analyzed by intention to treat.) Eighty-five percent of home auto-titrations were deemed successful; the others required in-lab titrations. (n=296) AJRCCM 2011;183:1238-1244.