Management of obstructive sleep apnea syndrome in the home. The role of portable sleep apnea recording.

Unattended four-channel sleep apnea recording has been shown to be an accurate tool in the diagnosis of moderate to severe obstructive sleep apnea. We selected 11 patients with severe obstructive sleep apnea who had an apnea-hypopnea index (AHI) determined by unattended sleep apnea recording. The mean AHI was 41 (SD, 17.5). We began nasal continuous positive airway pressure (NCPAP) at home empirically with 5 cm to 7.5 cm of pressure for several nights. We then adjusted the level of NCPAP after telephone interview with the patients and their significant others. The level of NCPAP was increased by 2.5-cm increments until the patients reported cessation of snoring and symptom improvement. The mean NCPAP was 8.0 cm (SD, 1.4). We repeated the overnight sleep apnea recording while on NCPAP in all patients at home to determine their response to therapy. All 11 patients had documented return of their AHI to normal (mean AHI, 2.4; SD, 1.6). Statistically significant improvement was noted in the number of obstructive apneas, hypopneas, total respiratory events, and the AHI. Follow-up data confirmed that patients had improvement in their symptoms and remained compliant with therapy (mean follow-up = 18 months; SD, 10.2). No serious complications were encountered when NCPAP was introduced in an unattended setting. We were able to diagnose and treat these patients in an entirely outpatient setting.