Mobile health application to support CPAP therapy in obstructive sleep apnoea: design, feasibility and perspectives

Abstract

BackgroundCurrent continuous positive airway pressure (CPAP) devices can be monitored remotely; however, in-person visits are kept for clinical follow-up in order to promote CPAP use and resolve potential side-effects. Mobile health is a promising way to provide remote and easy clinical control for CPAP follow-up and support. We aimed to evaluate the feasibility and acceptance by obstructive sleep apnoea (OSA) patients and healthcare professionals of a newly designed mobile app (Appnea-Q) to promote clinical control through a self-monitoring tool for patients with CPAP supervised by sleep professionals.MethodsAppnea-Q incorporates a simple follow-up questionnaire with automated responses, together with frequent problems and lifestyle recommendations sections. Feasibility, acceptance and usefulness were assessed. First, an internal validation was performed during outpatient CPAP follow-up visits with sleep professionals from various sleep units. Second, an external validation was performed in a subgroup of 15 patients at home.ResultsMost patients (n=75) considered the app useful and were willing to use it and recommend it (72–88%). Up to 64.87% agreed on its capacity to reduce hospital visits. Appnea-Q was rated as acceptable (79.37±19.29) by the system usability score. Sleep professionals (n=30) concurred on its usefulness for OSA patient follow-up, particularly during the first month of CPAP therapy. The external validation showed its feasibility among 11 out of 15 patients and their data were received accordingly on the professionals' web platform.ConclusionsAccording to our validation process, and the viewpoints of the patients and professionals, our new mobile app is a feasible and well-received tool for personal OSA management. Future clinical trials should substantiate its performance and cost-effectiveness in the clinical arena.

An Internet of Medical Things System to Increase Continuous Positive Airway Pressure Usage in Patients with Sleep-Disordered Breathing

“…These additional sensors may include ankle accelerometers to estimate leg movements during sleep [8], voltage sensors to measure the electrocardiogram, optic sensors to measure haemoglobin oxygen saturation, and the smartphone microphone to measure respiratory sounds such as snoring. The low-cost and open-source characteristics of our system may also allow integration with third-party mobile health applications such as the recently designed Appnea-Q mobile app [13] as well as with third-party wearable monitors [18].…”

“…Some CPAP device manufacturers provide web platforms allowing physicians and patients to receive data on compliance, apnea-hypopnea index (AHI) and mask leaks (Table 1). However, companies employ their own proprietary algorithms making it difficult to carefully interpret the results [13]. The lack of standardization also hinders interoperability with existing electronic patient records and may be a problem for health care systems that employ CPAP devices of multiple brands [15].…”

“…A similar concept has been formulated in a patent application (WO 2016/192941 A1). The concept that the adoption of telemedicine may support OSA management and help obtain adequate adherence to CPAP is progressively gaining ground also in published literature [1,2,13,15,16].…”

On‐demand mobile health infrastructures to allow comprehensive remote atrial fibrillation and risk factor management through teleconsultation

“…[17,28] outcomes such as satisfaction and cost-effectiveness. [29,30] Technologies for longitudinal monitoring of lifestyle components and AF risk factors are available and may support a more complete remote assessment and management of AF patients in the future, once these tools can be implemented in existing clinical pathways or emerging mHealth approaches. In addition to the assessment of risk factors, mHealth infrastructures and apps can also be helpful in applying dedicated in-app coaching to improve lifestyle and control risk factors by behavioral changes.…”

“…[ 17,28 ] Several clinical trials have demonstrated the feasibility of mHealth‐based sleep apnea management compared with a more traditional in‐person care model, suggesting non‐inferiority in terms of adherence to continuous positive airway pressure treatment and compliance as well as functional outcomes such as satisfaction and cost‐effectiveness. [ 29,30 ]…”