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Advantages and disadvantages of home versus in-laboratory PAP titration

Advantages and disadvantages of home versus in-laboratory PAP titration
In-laboratory titration Home APAP titration
Advantages
  • May be combined with a diagnostic polysomnogram ("split night study")
  • Ability to make quick adjustments of mask fit, humidification, expiratory pressure management, and others
  • Better ability to sample and titrate PAP in all sleep stage/position combinations
  • Ability to recognize treatment-emergent central apnea activity and manage it (multi-modality titration study)
  • Adequate patient education by a trained sleep technologist
  • Real time visual confirmation of efficacy of therapy
  • Lower cost, especially if combined with prior home sleep apnea testing
  • Reduced time away from home
  • More easily available in medically underserved areas
  • Faster time to therapy
  • Similar outcomes to fixed CPAP titrated in an attended setting when utilized in patients with uncomplicated moderate to severe OSA
Disadvantages
  • Slower time to diagnosis and therapy if diagnosis and PAP titration are done on separate nights
  • Higher cost
  • The need to spend a night away from home
  • Inadequate patient education
  • Inability to address problems related to mask fit, leak, and other PAP related issues
  • Inability to detect and acutely manage treatment-emergent central sleep apnea
PAP: positive airway pressure; APAP: autotitrating continuous positive airway pressure; OSA: obstructive sleep apnea.
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