Cost-Effectiveness Analysis of Automatic Titration of Continuous Positive Airway Pressure at Home in 1 Night Versus 2 Nights

Objective To assess the cost-effectiveness of automatic continuous positive airway pressure (CPAP) titration at home on 1 night or 2 consecutive nights in patients with the sleep apnea-hypopnea syndrome (SAHS). Patients and methods A home titration study was performed using automatic CPAP for 2 consecutive nights on 100 patients with SAHS and an indication for CPAP. The number of successful studies and the costs of the first night and both nights were analyzed. The pressure requirements on each night and the agreement between the pressures selected visually by 2 different observers were compared. Results CPAP titration was successful in 85% and 80% of patients on the first night and second night, respectively, and in 88% of patients after both nights. No significant differences between the 2 nights were found for the following parameters: 95th percentile pressure (mean [SD], 10.2 [1.8] cm H 2 O and 10.2 [1.6] cm H 2 O on the first and second nights, respectively), mean pressure (7.8 [1.7] cm H 2 O and 7.7 [1.7] cm H 2 O), or the pressure selected visually (9.4 [1.5] cm H 2 O and 9.4 [1.4] cm H 2 O). Interobserver agreement on the pressure selected was good: the κ statistics were 0.956 for the first night and 0.91 for the second night. The 1-night study cost €232.63 and the 2-night study cost €227.93. Conclusions Automatic CPAP titration at home for 1 night enables a substantially greater number of patients to be studied at a similar cost than is possible when titration is accomplished in 2 consecutive nights.