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Obstructive sleep apnea is underdiagnosed and therefore undertreated, in part because the diagnosis and initial management involve overnight polysomnography (PSG). To test an approach without PSG, investigators identified 68 patients likely to have moderate-to-severe sleep apnea according to (1) a sleepiness questionnaire, (2) a clinical score based on witnessed apnea, neck circumference, and hypertension, and (3) measurements from home overnight oximetry, including respiratory effort, airflow, snoring, and leg movements.
These patients were randomized to either two nights of PSG (1 for diagnosis and 1 for continuous positive airway pressure [CPAP] titration), or to home CPAP autotitration and adjustments based on software measurements and h…