Telemedicine in Sleep-Disordered Breathing

Abstract

Telemedicine has applications in all stages of the diagnosis, treatment, and follow-up of patients with sleep-disordered breathing. Diagnostic applications include telemonitored polysomnography, communication of test results and therapeutic options, and remote continuous positive airway pressure titration. Online compliance monitoring results in similar and in some cases improved compliance when compared with traditional face-to-face evaluations. The impact of telemedicine on compliance depends on the preexisting organization of standard care in the routine setting. Combining theory-driven behavioral approaches with telemedicine technology could hold the answer to increasing real-world adherence rates. Targeted troubleshooting and support based on individual patient data, web-, and/or app-based teaching, and combinations via a smartphone app or coaching website is feasible. Telemedicine is likely cost-effective but requires better evidence.

Telemonitoring for the Follow-Up of Obstructive Sleep Apnea Patients Treated with CPAP: Accuracy and Impact on Therapy

“…Based on a compilation of seven studies, Verbraecken has also proposed an algorithm with a similar cut-off [ 18 ]. AHI ≥ 10 should be managed.…”

“…AHI ≥ 10 should be managed. In cases of obstructive events, attention is focused on the level of pressure, nasal obstruction, and mask type, and in cases involving central events, medical support is required [ 18 ]. The number of consecutive days over which the problem must persist is not described, but it is between 2–5 days in the majority of the studies on which this algorithm is based.…”

“…CPAP use is highly dependent on the willingness of the patient to use the device and to apply the mask while sleeping [ 18 ]. In order to assess CPAP use, two terms should be distinguished: adherence refers to the real use of CPAP when this treatment has been prescribed (yes/no) while compliance refers to the daily usage expressed in hours (or minutes) per night in persistent users [ 19 ].…”

“…Finally, TM has entered the daily life of many family households through the growing use of connected monitoring tools (e.g., apps, watches, accelerometers) that collect physiological parameters such as blood pressure, sleep measurements, physical activity, and weight. In the future, all of these parameters, including those concerning CPAP treatment, could be integrated into a more comprehensive health monitoring strategy [ 18 ]. However, healthcare professionals should be careful to avoid dehumanization of care through TM.…”

Using Telemedicine to Monitor the Patient with Chronic Respiratory Failure

“…Finally, almost all ventilator types are different, and knowing all the algorithms operating in the available machines in commerce is difficult, which may generate difficulties or even mistakes [48]. Marked differences can occur in ventilator performance, mode of triggering, pressurisation slope, and type of exhalation; in addition, leaks and changes in upper airway resistance may modify these patterns [21,67].…”