Conventional Polysomnography Is Not Necessary for the Management of Most Patients with Suspected Obstructive Sleep Apnea
Corral 2017 trial design and results
Design
Non-inferiority randomised controlled trial
Treatment
Home respiratory polygraphy management pathway
Control
In-laboratory polysomnography management pathway
Population
Patients with suspected obstructive sleep apnoea
Follow-up
6 months
Primary endpoint
Epworth Sleepiness Scale score, tested for non-inferiority
Result
The respiratory polygraphy protocol was non-inferior to polysomnography on the Epworth scale, with similar quality of life, blood pressure and sleep study findings. It was the most cost-effective protocol, at EUR 416.70 less per patient.
Secondary endpoints
Cost, quality of life, blood pressure, CPAP adherence
Home respiratory polygraphy management is similarly effective to polysomnography, with a substantially lower cost. Therefore, polysomnography is not necessary for most patients with suspected sleep apnea.
The trial authors, in the published abstract
How it has aged
The evidence behind home testing as the default pathway, and one of the more consequential de-implementation results in respiratory medicine: it removed a rate-limiting, expensive, inpatient investigation from most of the diagnostic pathway. The qualifier is 'most patients' — complex or comorbid cases still need the laboratory.
Publications
Conventional Polysomnography Is Not Necessary for the Management of Most Patients with Suspected Obstructive Sleep Apnea. Noninferiority, Randomized Controlled Trial
Corral J, Sánchez-Quiroga MÁ, Carmona-Bernal C, et al. Conventional Polysomnography Is Not Necessary for the Management of Most Patients with Suspected Obstructive Sleep Apnea. Noninferiority, Randomized Controlled Trial. Am J Respir Crit Care Med 2017 Nov 1;196(9):1181-1190.
Home respiratory polygraphy non-inferior to polysomnography for management