Does remote monitoring change OSA management and CPAP adherence?

Abstract

It is increasingly recognized that the high prevalence of obstructive sleep apnoea (OSA), and its associated cardio-metabolic morbidities make OSA a burden for society. Continuous positive airway pressure (CPAP), the gold standard treatment, needs to be used for more than 4 h/night to be effective, but suffers from relatively poor adherence. Furthermore, CPAP is likely to be more effective if combined with lifestyle changes. Thus, the remote telemonitoring (TM) of OSA patients in terms of CPAP use, signalling of device problems, following disease progression, detection of acute events and monitoring of daily physical activity is an attractive option. In the present review, we aim to summarize the recent scientific data on remote TM of OSA patients, and whether it meets expectations. We also look at how patient education and follow-up via telemedicine is used to improve adherence and we discuss the influence of the profile of the healthcare provider. Then, we consider how TM might be extended to encompass the patient's cardio-metabolic health in general. Lastly, we explore how TM and the deluge of data it potentially generates could be combined with electronic health records in providing personalized care and multi-disease management to OSA patients.

Sleep and Migraine: Assessment and Treatment of Comorbid Sleep Disorders

“…Though CPAP is the gold standard therapy for OSA, it is not accepted or tolerated by all patients. 51 CPAP devices are now equipped with wireless data monitoring, providing daily feedback scores for patients. The implanted hypoglossal nerve stimulator was FDA-approved in 2014 for treatment of OSA, with promising results in a subset of patients who have failed CPAP, have moderate to severe OSA, BMI ≤ 32, and other criteria.…”

“…49 A dose-response effect has been found between CPAP adherence and outcomes including daytime sleepiness, neurocognitive and functional outcomes, 50 and adherence can be increased by electronic monitoring and behavioral interventions. 51 CPAP devices are now equipped with wireless data monitoring, providing daily feedback scores for patients. Providers can access usage patterns and efficacy data online (Fig.…”

Telemedicine in the diagnosis and treatment of sleep apnoea

“…Obtaining adequate compliance remains the greatest challenge related to OSA treatment, and TM makes sense in this setting. In addition, the prevalence of OSA is growing and is associated with increased healthcare costs that could be streamlined by the application of TM [9,10]. As shown in table 2, TM can be utilised in all aspects of OSA patient management.…”

Update in respiratory sleep disorders: Epilogue to a modern review series

“…Efforts are underway to diagnose OSA using such technologies . Remote monitoring approaches may also be helpful to provide patient engagement and to allow clinicians to identify and intervene on patients who are struggling with therapy Plasma biomarkers to diagnose and risk stratify OSA: Biomarkers are being used increasingly to diagnose various conditions, for example plasma exosomes and microRNAs are being applied to OSA such that a clinician may ultimately be able to diagnose a patient with OSA based on a blood test .…”

“…We anticipate a number of areas of future study and development but summarize a few here: Big data approaches: Large databases are now being used by the sleep field to address issues with positive airway pressure (PAP) adherence, to study the natural history of OSA and to predict which patients may be at risk of important complications . Rigorous studies are needed to assess the new technologies, which are being developed to allow patient engagement and feedback, attempting to optimize PAP adherence Diet, exercise and sleep are the three pillars of health: Advocacy for the importance of sleep and sleep health is occurring via large‐scale public education efforts in many countries.…”