Telemedicine-Based Approach for Obstructive Sleep Apnea Management: Building Evidence

Abstract

BackgroundTelemedicine seems to offer reliable solutions to health care challenges, but significant contradictory results were recently found. Therefore, it is crucial to carefully select outcomes and target patients who may take advantage of this technology. Continuous positive airway pressure (CPAP) therapy compliance is essential to treat patients with obstructive sleep apnea (OSA). We believe that OSA patients could benefit greatly from a telemedicine approach for CPAP therapy management.ObjectiveThe objective of our study was to evaluate the application of a telemedicine-based approach in the CPAP therapy management, focusing on patients’ CPAP follow-up and training.MethodsWe performed two studies. First, (study 1) we enrolled 50 consecutive OSA patients who came to our sleep center for the CPAP follow-up visit. Patients performed a teleconsultation with a physician, and once finalized, they were asked to answer anonymously to a questionnaire regarding their opinion about the teleconsultation. In a second randomized controlled trial (RCT) (study 2), we included 40 OSA patients scheduled for CPAP training. There were 20 that received the usual face-to-face training and 20 that received the training via videoconference. After the session, they were blindly evaluated on what they learned about OSA and mask placement.ResultsMore than 95% (49/50) of the interviewed patients were satisfied with the teleconsultation, and 66% (33/50) of them answered that the teleconsultation could replace 50%-100% of their CPAP follow-up visits. Regarding the RCT, patients who received the CPAP training via videoconference demonstrated the same knowledge about OSA and CPAP therapy as the face-to-face group (mean 93.6% of correct answers vs mean 92.1%; P=.935). Performance on practical skills (mask and headgear placement, leaks avoidance) was also similar between the two groups.ConclusionsOSA patients gave a positive feedback about the use of teleconsultation for CPAP follow-up, and the CPAP training based on a telemedicine approach proved to be as effective as face-to-face training. These results support the use of this telemedicine-based approach as a valuable strategy for patients’ CPAP training and clinical follow-up.

Tele-monitoring of ventilator-dependent patients: a European Respiratory Society Statement

“…CPAP and NIV may benefit these patients . With the aim of improving compliance as well as finding new diagnostic strategies, some studies investigated the role of tele-monitoring in the management sleep disorders [81][82][83][84][85][86].…”

The role of telemedicine and mobile health in the monitoring of sleep-breathing disorders: improving patient outcomes

“…With this in mind, telemedicine-based strategies could be a major component in the development of a comprehensive and cost-effective solution for these aspects of common SDB, like OSA. 10 Advances in mobile technology, and their applications in sleep health, are progressing to a level where physiological signal acquisition and analysis can be carried out by a smartphone's built-in sensors, offering improved comfort and the possibility of home sleep monitoring to patients with sleep disorders. 11 We review the traditional diagnostic procedures and the present telemedicine tools and apps.…”

“…For example, Parikh et al 56 compared patient satisfaction and CPAP adherence based on videoconference (n=34) with face-to-face (n=56) specialist consultations, but showed similar compliance and satisfaction in both groups. In another study, Isetta et al 10 analyzed the satisfaction of 50 patients with OSA with a physician-based teleconsultation (videoconference), showing that >95% of patients were satisfied and that 66% would be happy to replace their CPAP follow-up visits with teleconsultations. Interestingly, they also included 40 patients with OSA who were scheduled to receive CPAP training and randomized them to receive usual face-to-face training or training via videoconference.…”

Technical Developments and Clinical Use of Telemedicine in Sleep Medicine

“…In a recent interesting study, Isetta et al [14] tested the feasibility of teleconsultation. Two different schemes were studied to assess whether teleconsultation could replace: (1) continuous positive airway pressure (CPAP) follow-up consultation (50 patients); (2) CPAP training consultation (40 patients randomized to receive face-to-face vs. teleconsultation).…”