Efficacy of a telemonitoring system in continuous positive airway pressure therapy in Asian obstructive sleep apnea

Abstract

Study Objectives: A telemonitoring system is a promising wireless technology that possibly enhances adherence to CPAP therapy. The study aimed to determine the effect of a telemonitoring system on CPAP therapy adherence among Asian patients with moderate-to-severe OSA. Methods: A prospective randomized controlled trial enrolled 60 Asian adults (70% male) with moderate-to-severe OSA. Thirty patients each were randomized to a group using CPAP with a telemonitoring system or a group using CPAP with usual care. The telemonitoring system functioned by transferring CPAP-usage data via cellular network. When there were any triggers occurring 2 nights consecutively (usage hours < 4 hours per night; leakage > 27 L/min or AHI > 5 events/h), the investigator contacted the patients. The primary outcome was the 4-week CPAP usage hours per night. The secondary outcomes included the percentage of good adherence (defined as a 4-week period of therapy with CPAP usage > 4 hours/night on > 70% of total days), median leakage per night, adverse events from CPAP therapy, sleep quality improvement, and daytime sleepiness reduction. Results: The mean AHI was 50.3 events/h. The mean 4-week CPAP usage hours per night were insignificantly higher in the telemonitoring group (5.16 ± 1.47 hours/night vs 4.42 ± 1.91 hours/night; P =.18). However, the percentage of good adherence was significantly higher in the telemonitoring group (64.2% vs 34.4%; P =.024). Median leakage per night was also significantly lower in the telemonitoring group. Furthermore, significant sleep quality improvement was observed in the telemonitoring group. Overall adverse events and daytime sleepiness reduction were not different. Conclusions: The telemonitoring system implementation showed a trend toward increasing CPAP nightly usage hours and significantly improved adherence and sleep quality among Asian patients with moderate-to-severe OSA.

Telemedicine in Sleep-Disordered Breathing

“…97 A few studies were conducted among Asian patients with OSA. Murase and colleagues 105 showed the noninferiority of a telemonitoring system at 3-month follow-up in CPAP adherence, whereas Chumpangern and colleagues 79,155,156 reported an insignificantly higher CPAP compliance, and adherence was significantly higher in the telemonitoring group.…”

“…77 A selection of filter settings reported in the literature or by companies is shown in Table 2. 6,7,76,78,79,80,81 For example, CPAP data are automatically sent to the health care provider on a daily basis and trigger automatic alarms in case of poor use for 2 consecutive nights (<4 h) or excessive mask leakage (>0.5 L/s). 81 Automatically triggered clinical actions can then be scheduled (Fig.…”

Continuum of care for patients with obstructive sleep apnea after one year from the COVID-19 pandemic onset: no time for further delays

“…Theoretically, as shown for previous SARS-CoV outbreaks, environmental contamination can lead to contamination of hands or medical devices and, in turn, to the transmission of the virus to patients or staff via nose, mouth or eyes [ 21 ]. Indeed, nosocomial outbreaks of SARS-CoV-2 have been well documented, [ 36 , 37 ], but the mode of transmission is not clearly established and a close contact of healthcare workers (HCW) with infected patients seems the main mechanism [ 38 , 39 , 40 ]. While it is well acquired that environmental contamination occurs, the transmission to human beings is not necessarily consequential [ 26 ].…”

“…Therefore, a remote titration, previously suggested, still remains a valid option, although sporadic cases can be safely adapted in the lab using proper protection. Furthermore, we believe that currently there is sufficient scientific support to recommend remote control of CPAP treatment [ 38 , 39 , 40 ].…”

“…Suggestions provided so far are largely supported by published data on CPAP therapy remote monitoring, one of the most explored aspects of sleep telemedicine [ 38 , 39 , 40 , 47 , 48 ]. There are some suggestions that telemonitoring CPAP, not only avoid contact with the patient but also may improve compliance with the treatment [ 37 , 38 , 39 ]. In those patients under chronic follow-up the use of telemedicine can have an essential role in monitoring their chronic status and in providing explanation if problems arise [ 77 ].…”