Functional outcome and treatment adherence in patients evaluated according to a home testing algorithm is not clinically inferior to that in patients receiving standard in-laboratory polysomnography.

No abstract

The prevalence of OSA in all patients considered for bariatric surgery was greater than 77%, irrespective of OSA symptoms, gender, menopausal status, age, or BMI. The prediction model that we developed for the presence of OSA (AHI ≥ 5 events per hour) has excellent discriminative ability (evidenced by an AUC value of 0.8). However, the negative prediction values for the presence of OSA were too low to be clinically useful due to the high prevalence of OSA in this high-risk group. We demonstrated that, by utilizing even the most stringent possible cutoff values for the prediction model, OSA cannot be predicted with enough certainty. Therefore, we advocate routine PSG testing for all patients that are considered for bariatric surgery.

Summary This study aimed to identify pre-treatment and immediate early treatment factors predicting continuous positive airway pressure (CPAP) use during the first week of therapy, when the pattern of non-adherence is established. Four domains of potential predictors were examined: pre-treatment demographic and clinical factors, patients’ perceived self-efficacy, treatment delivery (mask leak and bothering side effects), and immediate disease reduction (residual respiratory events and flow limitation). The Autoset™ Clinical System objectively documented daily CPAP use, mask leak, residual respiratory events, and flow limitation. Ninety-one CPAP-naïve patients with newly diagnosed obstructive sleep apnea were followed for 1 week after treatment initiation. Mean CPAP daily use during the first week was 3.4 ± 2.7 hours, with significantly lower use observed in Black than non-Black participants (2.7 vs. 4.4 hours, respectively, p= 0.002). Less intimacy with partners caused by CPAP was the only treatment side effect correlated with CPAP use (r= -0.300, p=0.025). Reduced CPAP use during the first week was simultaneously associated with being Black, higher residual apnea-hypopnea index, and the treatment side effect of less intimacy with partners. The three factors together accounted for 25.4% of the variance in the CPAP use (R2=0.254, p<0.01). These data suggest the need to assess the impact of CPAP on intimacy and troubleshoot aspects of the treatment that interfere with sexual relationships. Assessing the presence of residual respiratory events may be important in promoting CPAP adherence. The association of race and CPAP use needs to be further explored by including more socioeconomic information.