Inpatient Portable Sleep Testing (IPST): Diagnostic Value and SubsequentCPAPAdherence

Jeanne Wallace, MD; Ameer Moussa, MD; George Girgis, MD; Sharon DeCruz, MD; Phillip Deutsch, MS

PURPOSE: Sleep breathing disorders (SBD) are associated with high hospitalization rates. Diagnostic testing for hospitalized patients is usually deferred until after discharge. We compared results from inpatient portable sleep testing (IPST) and home sleep testing (HST) to confirm our hypothesis that IPST is feasible and provides similar CPAP adherence.

METHODS: Overnight IPST was performed in 2-bed patient rooms, ICU or stepdown units(SDU) during routine care. Overnight HST was set-up and interpreted at the Sleep Center. Stardust II(Philips) or Noxturnal T3(Carefusion) devices were used. Tracings were autoscored and edited using standard AASM criteria for apneas and alternative criteria for hypopneas (50% flow rate/3% SaO2 reduction). Patients diagnosed with SDB had autoCPAP titration and were followed by card adherence tracking. Comparisons were made using Bonferroni corrected student-t tests and normally approximated Z-tests.

RESULTS: During July 2012-March 2014, 135 IPSTs were ordered and 110(81%) completed in patient rooms 102(93%), ICU 3(3%) or SDU 5(5%). Twenty-five(19%) were not done due to: patient discharge 13(52%); refusal 6(24%); inappropriateness 4(16%) or technical difficulty 2(8%)). A comparison group of 97 outpatients had HST during January 2013-June 2014. The groups were similar in age (52.8+/-14.4 vs 47.9+/-11.5yr), BMI (40.0+/-11.4 vs 39.0+/-9.1) and male composition (55% vs 44%). IPST diagnoses included obstructive sleep apnea 68(72%), central sleep apnea 12(13%) and negative 14(15%). IPST was performed sooner after ordering than HST (0.33+/-0.86 vs 56.3+/- 98.8days); p<0.001). Supplemental O2 was used during 22(20%) IPST, but proportions of inadequate studies were similar (15% vs 7%). SBD diagnosis (72% vs 61%), and respiratory effort indices (39.2+/-25.8/hr vs 33.4+/-27.3/hr) were similar, but inpatients had lower SaO2 nadirs (70.4+/-10.7% vs 74.7+/-11.9%, p=0.006). Time to CPAP initiation after IPST was shorter (4.9+/-17.7 vs 31.9+/-56.3 days; p<0.001), but CPAP acceptance (88% vs 83%), adherence tracking return rates (91% vs 92%), CPAP use/14 days (10 +/-4.13 vs 11+/-3.27days) and nights with > 4 hr use (41% vs 46%) were similar.

CONCLUSIONS: IPST is feasible, provides useful results and is associated with similar rates of CPAP acceptance and adherence as HST.

Chest. 2015;148(4_MeetingAbstracts):1035A. doi:10.1378/chest.2251568