Effect of an ambulatory diagnostic and treatment programme in patients with sleep apnoea

The aim of this study to evaluate the efficacy of a home-based programme on clinical response, continuous positive airway pressure (CPAP) compliance and cost in a population of high pre-test probability of suffering obstructive sleep apnoea syndrome (OSAS). Patients were randomised into the following three groups. Group A: home respiratory polygraphy (RP) and home follow-up; group B: hospital polysomnography and hospital follow-up; and group C: home RP and hospital follow-up. Evaluation during 6 months included Epworth Sleepiness Scale (ESS), Functional Outcomes Sleep Questionnaire (FOSQ), and daily activity and symptom questionnaires. Compliance was assessed by memory cards (group A) and using an hourly counter (groups B and C). 66 patients were included (22 per branch), 83% were males, aged mean +/- SD 52 +/- 10 yrs, body mass index 34 +/- 7kg.m(-2), apnoea/hypopnoea index 43 +/- 20 h(-1), CPAP pressure 8 +/- 2 cmH(2)O, with no between-group differences. Clinical response showed an ESS of mean +/- SD 15 +/- 3 to 6 +/- 4, a FOSQ of 16 +/- 3 to 18 +/- 2, symptoms of 43 +/- 7 to 25 +/- 7, and activity of 37 +/- 11 to 25 +/- 8. At the end of the study, compliance was: group A 73%, group B 68% and group C 57%. The cost per patient was: group A (sic)590 +/- 43, group B (SIC)894 +/- 11 and group C (sic)644 +/- 93 (p<0.001). In conclusion, patients with a high initial probability of having OSAS can be diagnosed and treated in a home setting, with a high level of CPAP compliance and lower cost than using either a hospital-based approach or home RP/hospital follow-up.