Published ahead of print on October 14, 2004, doi:10.1164/rccm.200310-1360OC
Am. J. Respir. Crit. Care Med., Volume 171, Number 2, January 2005, 188-193
A more recent version of this article appeared on January 15, 2005
Submitted on October 8, 2003
Accepted on October 7, 2004
Clinical Utility of Home Oximetry Compared to Polysomnography for Assessment of Sleep Apnea
William A Whitelaw1*, Rollin F Brant1, and W. Ward Flemons1
1 Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
* To whom correspondence should be addressed. E-mail: wwhitela{at}ucalgary.ca.
The practical purpose of diagnostic assessment in most cases of obstructive sleep apnea is to predict which patients have symptoms that will improve on treatment. We measured the accuracy with which clinicians make this prediction using polysomnography compared with oximeter-based home monitoring. Patients referred to a sleep centre with suspicion of symptomatic obstructive sleep apnea were randomized to have polysomnography or home monitoring. Patients with comorbidity or physiologic consequences of sleep apnea were excluded. Sleep specialists estimated the likelihood of success of treatment as greater than 50% (predicted success) or less than 50% (predicted failure) based on clinical data and test results. All patients were treated for 4 weeks with auto-adjusting continuous positive airway pressure. Success was defined as an increase >1.0 in Sleep Apnea Quality of Life Index. Correct prediction rates were compared. 288 patients were enrolled. Initial patient characteristics, compliance and improvement in quality of life at 4 weeks were not different in the two groups. Correct prediction rate was 0.61 with polysomnography, 0.64 with home monitoring (NS). We conclude that the ability of physicians to predict the outcome of continuous positive airway treatment in individual patients is not significantly better with polysomnography than with home oximeter-based monitoring.
Key words: Home monitoring, outcomes, diagnosis, treatment
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