Please select the eligibility criteria that correspond to the clinical trial below.
Title: Portable Monitoring in the Diagnosis and Management of Obstructive Sleep Apnea
Brief Summary: This multi-site project compares compares the efficiency of a home-based portable monitoring strategy to a standard of care sleep laboratory-based strategy for the diagnosis and positive airway pressure treatment of obstructive sleep apnea in adults.


Options:
A: Inclusion Criterion:

1. Age 21-75
2. New Diagnosis of OSA with a baseline RDI ≥ 15 events/hr of sleep determined by either full night or split night PSG
3. Able and willing to provide written informed consent
4. Able to follow study procedures
5. Sub-optimal PSG titration with at least 3 hours of attempted PAP titration (defined below): and deemed by their physician as a titration failure

Sub-optimal PSG titration: at least one of the following:

1. Poor sleep efficiency during titration period (sleep efficiency ≤ 70%) (participants may be on sleep medications as per standard lab CPAP protocol ) or;
2. Frequent arousals based on three seconds of alpha frequency on EEG (non PLM-related) of 20 or greater per hour during the titration portion of the study or;
3. CPAP titration aborted due to participant's request (due to intolerance), or
4. Persistent sleep disruption despite therapeutic CPAP therapy and in the judgment of the reviewing physician, suggesting a low probability to CPAP adherence

Exclusion Criterion:

1. Participation in another interventional research study within the last 30 days
2. Major uncontrolled medical or psychiatric condition such as congestive heart failure, neuromuscular disease, renal failure etc.
3. Prior CPAP or Bi-Level PAP use (within last 2 years)
4. Chronic respiratory failure or insufficiency, moderate COPD (FEV1 \< 60%), or any known condition of an elevation of arterial carbon dioxide levels while awake
5. Surgery of the upper airway, nose, sinus, or middle ear within the previous 90 days
6. Presence of an untreated, diagnosable, non-OSA related sleep disorder (e.g. restless legs syndrome, insomnia, etc.)
7. Periodic Limb movement arousal index of 10 or greater.
8. Refusal to consider further interventions to standard CPAP to optimize positive pressure therapy (e.g. different mask than what was used in lab)
9. PAP therapy otherwise medically complicated or contraindicated such as those with a difficult to size or adjust interface (mask) resulting in facial pain, skin irritation or trauma, or excessive air leaks
10. Shift workers or people experiencing jet lag
11. Known history of alcohol and or drug abuse
12. Diagnosis of Complex Sleep Apnea, (appears to be classic obstructive or mixed sleep apnea, but exhibits disruptive central apneas and periodic breathing on CPAP) 11, 12 or persistent central apnea during diagnostic PSG.
13. Diagnosis of Attention Deficit Hyperactivity Disorder
14. Chronic Hypnotic use (nightly use for three months or less)
B: Inclusion Criteria:

* age between 18 and 80 years
* patients who gave written informed consent
* patients who subscribed a social insurance
* SAOS patients who need CPAP treatment.

Exclusion Criteria:

* cardiac failure known and treated
* central Apnea syndrome
* patients who stopped CPAP treatment in the previous year
* pregnant women
* patients under guardianship
* imprisoned patients, patients in hospital
* patients included in an other clinical study
C: Inclusion Criteria:

* patient with OSA (AHI ≥20 / h)
* patient with daytime sleepiness
* naive of any pressure treatment of OSA
* patient able to provide written informed consent
* not a vulnerable person or legally protected adult.

Exclusion Criteria:

* pregnancy
* Person deprived of liberty or subject to a legal protection measure.
* Patient with serious heart failure (According to investigator judgment)
* patient with central sleep apnea index above 20% of AHI
* Patient with a significant intercurrent pathology that can influence the results. (According to investigator judgment).
D: Inclusion Criteria:

* Intermediate to high probability of having OSA based on an adjusted neck circumference \> 43 cm (17 inches)
* Presence of excessive daytime sleepiness (Epworth sleepiness scale ≥ 12) Apnea-hypopnea index \>= 15 on diagnostic testing to continue in study

Exclusion Criteria:

* Severe chronic insomnia, other condition with \< 4 hrs of sleep per night
* Unstable medical conditions
* Major psychiatric diagnosis
* Unable to undergo home testing
* Concerns about unsafe driving
* Severe COPD or restrictive lung disease
* Chronic narcotic use
* Alcohol abuse
* History of cataplexy
* Moderate to severe restless legs syndrome symptoms
* Pre-existing diagnosis of sleep apnea
* Prior experience with positive airway pressure treatment of sleep apnea
* Anticipated upper airway surgery or gastric bypass surgery in 4 months
* Decisional impairment for consenting
* Hypoventilation syndrome, identified in the medical record
* Waking oxygen saturation \< 92%

Answer: D