A systematic review and meta-analysis on the efficacy and safety of un-attended home auto-CPAP titration versus in-laboratory CPAP titration for moderate to severe obstructive sleep apnea

Abstract

Obstructive sleep apnea (OSA) is the leading sleep-related breathing disorder. The gold standard approach is titration during a full-night, attended, in-laboratory PSG. In-home titration uses auto-titrating continuous positive airway pressure (auto-CPAP) devices which contains event detection software and apply variable pressure according to the needs of the patient. The aim of this paper is to evaluate the evidence regarding the efficacy and safety of un-attended home Auto-CPAP (APAP) titration versus in-laboratory CPAP titration for moderate to severe obstructive sleep apneas (OSA). MEDLINE, clinicaltrials.gov and the Cochrane Library were searched for randomized controlled trials comparing in-home titration with APAP against standard continuous positive airway pressure (CPAP) titration in adults with moderate to severe OSA. Titration using home APAP and in-laboratory CPAP titration resulted in similar post-treatment AHI, ESS and compliance (moderate strength of evidence). Evidence to conclude that APAP is superior to CPAP is low. There is insufficient evidence regarding the safety of APAP as a titration method. Based on the quality of evidence on AHI, ESS and compliance, home APAP titration may be an alternative to standard in-laboratory titration in adult patients diagnosed with moderate to severe OSA without any of the following: unstable comorbid condition such as unstable cardiac disease or chronic lung disease; central sleep apneas such as CSA with Cheyne-Stokes breathing or other sleep disordered breathing, morbid obesity or psychophysical disability.