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 (multimodality 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 continuous PAP 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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