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Oliver C, Li H, Biswas B, Woodstoke D, Blackman J, Butters A, Drew C, Gabb V, Harding S, Hoyos CM, Kendrick A, Rudd S, Turner N, Coulthard E. A systematic review on adherence to continuous positive airway pressure (CPAP) treatment for obstructive sleep apnoea (OSA) in individuals with mild cognitive impairment and Alzheimer's disease dementia. Sleep Med Rev 2024; 73:101869. [PMID: 37924680 DOI: 10.1016/j.smrv.2023.101869] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 10/05/2023] [Accepted: 10/16/2023] [Indexed: 11/06/2023]
Abstract
Obstructive sleep apnoea (OSA) is highly prevalent in mild cognitive impairment (MCI) and Alzheimer's disease (AD). The gold standard treatment for OSA is continuous positive airway pressure (CPAP). Long-term, well-powered efficacy trials are required to understand whether CPAP could slow cognitive decline in individuals with MCI/AD, but its tolerability in this group remains uncertain. The present review investigates CPAP adherence among individuals with OSA and MCI/AD. Electronic searches were performed on 8 databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Six independent studies and four secondary analyses included 278 unique participants (mean age = 72.1 years). In five of the retained studies, around half of participants (45% N = 85 MCI, 56% N = 22 AD) were adherent to CPAP, where ≥4 h use per night was considered adherent. Three of the retained studies also reported average CPAP use to range between 3.2 and 6.3 h/night. CPAP adherence in individuals with MCI and AD is low, albeit similar to the general elderly population. Reporting adherence in future studies as both average duration as well as using a binary cut-off would improve our understanding of the optimum CPAP use in dementia clinical trials and care.
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Affiliation(s)
- Cerys Oliver
- Cardiff University, Cardiff, UK; University of Bristol, Bristol, UK
| | - Haoxuan Li
- University of Bristol, Bristol, UK; University Hospitals Bristol and Weston NHS Trust, Bristol, UK
| | | | | | - Jonathan Blackman
- University of Bristol, Bristol, UK; North Bristol NHS Trust, Bristol, UK
| | | | | | | | | | - Camilla M Hoyos
- Woolcock Institute of Medical Research, Macquarie University, Sydney, Australia
| | - Adrian Kendrick
- University of Bristol, Bristol, UK; University Hospitals Bristol and Weston NHS Trust, Bristol, UK; University of the West of England, Bristol, UK
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2
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Simonelli C, Vitacca M, Salvi B, Saleri M, Paneroni M. Comparison among three different follow-up models for obstructive sleep apnea syndrome patients: focus on the physiotherapist's role. Monaldi Arch Chest Dis 2023. [PMID: 37817742 DOI: 10.4081/monaldi.2023.2673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 09/28/2023] [Indexed: 10/12/2023] Open
Abstract
In obstructive sleep apnea syndrome (OSAS) subjects different follow-up modalities have been proposed to improve adherence to the continuous positive airway pressure (CPAP) device. This retrospective study compares three different health professional approaches dedicated to caring OSAS patients in three consecutive follow-up periods of 15 months each. The three different follow-up models are: i) physician-oriented follow-up (P-F); ii) physiotherapist-oriented follow-up (PT-F); and iii) tele-titration plus PT-oriented follow-up (TT-PT-F). Health personal visits and actions delivered, patients' adherence, CPAP efficacy, and problems under CPAP use were considered for comparison. Data from 122 OSAS patients with a new prescription of CPAP were analyzed: 39 (32.0%) in the P-F, 38 (31.1%) in the PT-F, and 45 (36.9%) in the TT-PT-F period. We found a reduction over time (from 40.9% in P-F to 8.2% in TT-PT-F, p<0.001) in patients missing the 1-year follow-up visit. The PT-F and TT-PT-F lead to a reduction in physician visits in comparison to P-F (5.2% and 8.9% vs 100%, p<0.001) with no differences in time to the first follow-up visit, CPAP efficacy, and patients' adherence among the three periods. More device-related problems were found in the PT-F (57.8%), compared with the PF (25.6%) period (p<0.001); the most common troubles were mask problems evaluated in 26.2% of cases. In conclusion, different follow-up models offer similar efficacy and short-term adherence for CPAP leading to a significant reduction in physician visits under the PT-F with or without tele-titration, being mask problems as the most commonly treated. Further analysis should be useful to define the best cost-efficacy follow-up intervention.
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Affiliation(s)
- Carla Simonelli
- Cardio-Respiratory Rehabilitation, ICS Maugeri IRCCS, Institute of Lumezzane (BS).
| | - Michele Vitacca
- Respiratory Rehabilitation, ICS Maugeri IRCCS, Institute of Lumezzane (BS).
| | - Beatrice Salvi
- Cardio-Respiratory Rehabilitation, ICS Maugeri IRCCS, Institute of Lumezzane (BS).
| | - Manuela Saleri
- Cardio-Respiratory Rehabilitation, ICS Maugeri IRCCS, Institute of Lumezzane (BS).
| | - Mara Paneroni
- Cardio-Respiratory Rehabilitation, ICS Maugeri IRCCS, Institute of Lumezzane (BS).
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Pei G, Ou Q, Lao M, Wang L, Xu Y, Tan J, Zheng G. APAP Treatment Acceptance Rate and Cost-Effectiveness of Telemedicine in Patients with Obstructive Sleep Apnea: A Randomized Controlled Trial. Nat Sci Sleep 2023; 15:607-622. [PMID: 37560381 PMCID: PMC10408676 DOI: 10.2147/nss.s416221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 07/27/2023] [Indexed: 08/11/2023] Open
Abstract
PURPOSE This study evaluated the treatment acceptance rate and cost-effectiveness of the telemedicine model in clinical practice for adult patients with obstructive sleep apnea (OSA). PATIENTS AND METHODS Patients admitted to the sleep center for snoring were randomly divided into telemedicine and control groups. Patients diagnosed with moderate-to-severe OSA using the Home Sleep Apnea Test (HSAT) were voluntarily treated with auto-adjusted positive airway pressure (APAP) therapy. The acceptance rate of the APAP treatment, cost of patient visits, time cost, and labor cost of doctors in the two groups were observed. RESULTS A total of 57 subjects were included, with an average age of 40.12±11.73 years, including 47 males (82.5%); 26 patients were in the telemedicine group, and 31 were in the control group. Follow-up results showed that the acceptance rate of APAP treatment was 57.7% and 54.8% in the telemedicine and control groups, respectively, with no significant difference between the two groups (p=0.829). The cost-benefit analysis showed that the telemedicine group reduced the cost of patients' medical treatment [-457.84(-551.19,1466.87)] but increased the extra intervention frequency and time outside the doctor's office. Further analysis showed that male subjects of older age, higher education level, distant residence, no fatty liver, poor sleep quality, severe insomnia, and higher OSA severity were more likely to receive telemedicine diagnosis and treatment. CONCLUSION The APAP treatment acceptance rate and compliance of OSA patients in the telemedicine group were similar to those in the control group, and the cost of patients' medical treatment was reduced. However, telemedicine increases the frequency and duration of additional out-of-hospital interventions.
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Affiliation(s)
- Guo Pei
- Department of Sleep Center, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, People’s Republic of China
- School of Medicine, South China University of Technology, Guangzhou, 510006, People’s Republic of China
| | - Qiong Ou
- Department of Sleep Center, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, People’s Republic of China
- School of Medicine, South China University of Technology, Guangzhou, 510006, People’s Republic of China
| | - Miaochan Lao
- Department of Sleep Center, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, People’s Republic of China
| | - Longlong Wang
- Department of Sleep Center, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, People’s Republic of China
| | - Yanxia Xu
- Department of Sleep Center, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, People’s Republic of China
| | - Jiaoying Tan
- Department of Sleep Center, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, People’s Republic of China
| | - Gaihong Zheng
- Department of Sleep Center, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, People’s Republic of China
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Bates NA, Huffman A, Goodyear E, Nagai T, Rigamonti L, Breuer L, Holmes BD, Schilaty ND. Physical clinical care and artificial-intelligence-guided core resistance training improve endurance and patient-reported outcomes in subjects with lower back pain. Clin Biomech (Bristol, Avon) 2023; 103:105902. [PMID: 36805199 DOI: 10.1016/j.clinbiomech.2023.105902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 01/19/2023] [Accepted: 01/30/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND Low back pain is an extremely prevalent issue with an extensive impact, ranging from decreased quality of life to lost years of productivity. Many interventions have been developed to alleviate chronic lower back pain, yet it remains a widespread problem. The objective of this study was to examine the role of artificial intelligence guided resistance training relative to clinical variables in subjects experiencing lower back pain. METHODS 69 out of 108 enrolled and 92 accrued subjects completed the 8-week intervention. Subjects were randomized into four groups (Control, Training, Clinical, or Combined). The Training cohort received supervised artificial-intelligence-guided core-focused resistance training while the Clinical group received clinical care. The Combined group received both clinical care and artificial-intelligence-guided training and the Control group received no treatment. Participants were evaluated using functional testing and patient-reported outcomes at baseline, 4 weeks, and 8 weeks. FINDINGS In the clinical tests, the Clinical and Combined cohorts showed increased total time for isometric extensor endurance and the Clinical cohort increased total distance traveled in the 6-min walk test at 8 weeks. The Training, Clinical, and Combined groups showed improvements in Patient-reported outcomes after 8 weeks. Most of the significant improvements were only seen at the 8-week evaluation for both the clinical evaluations and Patient-reported outcomes. The Control group did not show significant improvements in any outcome measures. INTERPRETATION The present data indicate that core-focused interventions, including artificial-intelligence-guided moderate-resistance exercise, can increase objective functional outcomes and patient satisfaction using Patient-reported outcomes in individuals with lower back pain.
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Affiliation(s)
- Nathaniel A Bates
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA; Division of Sports Medicine, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
| | - Allison Huffman
- The Ohio State University School of Medicine, Columbus, OH, USA
| | - Evelyn Goodyear
- The Ohio State University School of Medicine, Columbus, OH, USA
| | - Takashi Nagai
- Division of Sports Medicine, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA; United States Army Research Institute of Environmental Medicine, Natick, MA, United States of America
| | - Luca Rigamonti
- Division of Sports Medicine, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA; Department of Orthopedic Surgery, Policlinico San Pietro, Ponte San Pietro, Italy
| | - Logan Breuer
- Division of Sports Medicine, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Nathan D Schilaty
- Division of Sports Medicine, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA; Department of Neurosurgery & Brain Repair, University of South Florida, Tampa, FL, USA; Center for Neuromusculoskeletal Research, University of South Florida, Tampa, FL, USA
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Alhassan GN, Bosnak AS, Hamurtekin E. Perceived satisfaction and outcomes from drug information center services provided with a telehealth approach. Niger J Clin Pract 2022; 25:2053-2061. [PMID: 36537465 DOI: 10.4103/njcp.njcp_552_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
BACKGROUND AND AIM Telehealth expansion is dependent on the acceptance and satisfaction of the providers and users of the telehealth service and the impact on the overall health-care system. This study was conducted to evaluate the outcome of pharmacist-led telehealth services and satisfaction of their users. MATERIALS AND METHODS The telehealth-based drug information center service was an 8-month retrospective, descriptive study that evaluated users' service satisfaction (quality of service), general health outcomes, recommendations, and personal health outcomes by electronically distributing a questionnaire to the users using a Donabedian model approach. RESULTS The feedback response rate was 87.33% (N = 131). The majority of users were 25-34-year-old young adults, while regarding the background status of the enquirers (health-care worker, medical doctor, nurse, patient, phar macist, practitioner/scientist), 35 (26.7%) pharmacists and 34 (26.0%) patients were the most prevalent users. In terms of service satisfaction and health outcome, medical doctors had the highest mean ratings of 4.67 ± 0.76 and 4.95 ± 0.21, respectively. Evaluation of the pharmacist-led telehealth impact was measured with four variables, which showed a statistical significance of P < 0.001 and a highly positive mean rating generally (service satisfaction 4.44 ± 0.83, general health outcome 4.54 ± 0.85, personal health outcome 4.80 ± 0.58, and recommendation 4.85 ± 0.43). The findings also showed that user satisfaction significantly impacted on personal health outcomes (P < 0.001), and that there was an insignificant relationship between user background status and continents. CONCLUSIONS The study reveals the significant impact of pharmacist-led telehealth services and the importance of incorporating telehealth services into drug information centers.
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Affiliation(s)
- G N Alhassan
- Department of Clinical Pharmacy, Faculty of Pharmacy, Cyprus International University, North Cyprus, Turkey
| | - A S Bosnak
- Department of Clinical Pharmacy, Faculty of Pharmacy, Cyprus International University, North Cyprus, Turkey
| | - E Hamurtekin
- Department of Pharmacology, Faculty of Pharmacy, Eastern Mediterranean University, North Cyprus, Turkey
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Kosky C, Madeira N, Boulton K, Hunter MT, Ling I, Reynor A, Sturdy G, Walsh J, Dhaliwal S, Singh B, Eastwood P, McArdle N. Telemedicine compared to standard face-to-face care for CPAP treatment: real-world Australian experience. Sleep 2022; 45:6643327. [PMID: 35830509 DOI: 10.1093/sleep/zsac157] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 06/21/2022] [Indexed: 11/14/2022] Open
Abstract
STUDY OBJECTIVES We tested a telemedicine model of care to initiate continuous positive airway pressure (CPAP) for patients with obstructive sleep apnea (OSA) living in remote Western Australia. METHODS A prospective study comparing telemedicine for CPAP initiation in a remote population versus standard face-to-face CPAP initiation in a metropolitan population. The primary outcome was average nightly CPAP use in the final week of a CPAP trial. RESULTS A total of 186 participants were allocated to either telemedicine (n=56) or standard care (n=130). The average distance from the study centre for the telemedicine group was 979 km (±792km) compared to 19km (±14km) for the standard care group. The CPAP trial duration in the standard care group was less than the telemedicine group (37.6 vs 69.9 days, p<0.001). CPAP adherence in the telemedicine group was not inferior to standard care (Standard 4.7±0.2 hours, Telemedicine 4.7±0.3 hours, p=0.86). No differences were found between groups in residual apnea-hypopnea index, symptom response, sleep specific quality of life at the end of the trial and continued CPAP use (3 to 6 months). Participant satisfaction was high in both groups. Total health care costs of the telemedicine model were less than the standard model of care. An estimated A$4,538 per participant in travel costs was saved within the telemedicine group by reducing the need to travel to the sleep center for in-person management. CONCLUSIONS In remote dwelling adults starting CPAP for the treatment of OSA, outcomes using telemedicine were comparable to in-person management in a metropolitan setting.
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Affiliation(s)
- Christopher Kosky
- West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia.,Centre for Sleep Science, University of Western Australia, Crawley, Western Australia
| | - Neill Madeira
- West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia
| | - Kate Boulton
- West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia
| | - Marie-Therese Hunter
- West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia
| | - Ivan Ling
- West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia.,Centre for Sleep Science, University of Western Australia, Crawley, Western Australia
| | - Ayesha Reynor
- West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia.,Centre for Sleep Science, University of Western Australia, Crawley, Western Australia
| | - Gavin Sturdy
- West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia.,Centre for Sleep Science, University of Western Australia, Crawley, Western Australia
| | - Jennifer Walsh
- West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia.,Centre for Sleep Science, University of Western Australia, Crawley, Western Australia
| | - Satvinder Dhaliwal
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Bentley, Western Australia.,Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore.,Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia, Minden, Pulau Pinang, Malaysia.,Singapore University of Social Sciences, Office of the Provost. 463 Clementi Road, Singapore
| | - Bhajan Singh
- West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia.,Centre for Sleep Science, University of Western Australia, Crawley, Western Australia
| | - Peter Eastwood
- Flinders Health & Medical Research Institute, College of Medicine and Public Health, Flinders University, South Australia
| | - Nigel McArdle
- West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia.,Centre for Sleep Science, University of Western Australia, Crawley, Western Australia
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Pinnock H, Murphie P, Vogiatzis I, Poberezhets V. Telemedicine and virtual respiratory care in the era of COVID-19. ERJ Open Res 2022; 8:00111-2022. [PMID: 35891622 PMCID: PMC9131135 DOI: 10.1183/23120541.00111-2022] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 05/04/2022] [Indexed: 11/05/2022] Open
Abstract
The World Health Organization defines telemedicine as “an interaction between a health care provider and a patient when the two are separated by distance”. The COVID-19 pandemic has forced a dramatic shift to telephone and video consulting for follow up and routine ambulatory care for reasons of infection control. Short Message Service (“text”) messaging has proved a useful adjunct to remote consulting allowing transfer of photographs and documents. Maintaining non-communicable diseases care is a core component of pandemic preparedness and telemedicine has developed to enable (for example) remote monitoring of sleep apnoea, telemonitoring of chronic obstructive pulmonary disease, digital support for asthma self-management, remote delivery of pulmonary rehabilitation. There are multiple exemplars of telehealth instigated rapidly to provide care for people with COVID-19, to manage the spread of the pandemic, or to maintain safe routine diagnostic or treatment services.Despite many positive examples of equivalent functionality and safety, there remain questions about the impact of remote delivery of care on rapport and the longer-term impact on patient/professional relationships. Although telehealth has the potential to contribute to universal health coverage by providing cost-effective accessible care, there is a risk of increasing social health inequalities if the “digital divide” excludes those most in need of care. As we emerge from the pandemic, the balance of remote versus face-to-face consulting, and the specific role of digital health in different clinical and healthcare contexts will evolve. What is clear is that telemedicine in one form or another will be part of the “new norm”.
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Labarca G, Schmidt A, Dreyse J, Jorquera J, Barbe F. Telemedicine interventions for CPAP adherence in obstructive sleep apnea patients: Systematic review and meta-analysis. Sleep Med Rev 2021; 60:101543. [PMID: 34537668 DOI: 10.1016/j.smrv.2021.101543] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 08/07/2021] [Accepted: 08/23/2021] [Indexed: 12/11/2022]
Abstract
Continuous positive airway pressure (CPAP) is the preferred therapy in patients with obstructive sleep apnea (OSA). However, data suggests treatment adherence is low. In recent years, telemedicine-based intervention (TM) has been evaluated to increase adherence. In this systematic review and meta-analysis of randomized controlled trials (RCTs), we evaluated the efficacy of TM on CPAP adherence in patients with OSA. Two independent reviewers explored five databases; the risk of bias (RoB) was evaluated using the Cochrane tool. Outcomes were defined as the mean difference (MD) in CPAP use per night and the proportion of patients with increased CPAP adherence of ≥4 h/night. The meta-analysis was conducted following the DerSimonian-Laird method, and the certainty of the evidence was rated according to GRADE. We included 16 RCTs including 3039 participants. The RoB was low in 12/16 studies. TM was associated with an increase in CPAP adherence of 29.2 min/night, I2 =75% (p < 0.01), and CPAP adherence ≧4 h/night, RR: 1.09 (1.02-1.17), I2 =22%. Subgroup analyses reported better results between three and 6 months, in the sleepy subgroup. Finally, based on the results obtained in this systematic review, there is favorable evidence regarding the treatment with TM in patients with OSA using CPAP. REVIEW REGISTRATION NUMBER: CRD42020165367.
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Affiliation(s)
- Gonzalo Labarca
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Clinical Biochemistry and Immunology, Faculty of Pharmacy, University of Concepcion, Concepcion, Chile.
| | - Alexia Schmidt
- Faculty of Medicine, University of Concepcion, Concepcion, Chile
| | - Jorge Dreyse
- Centro de Enfermedades Respiratorias y Grupo de Estudio Trastornos Respiratorios Del Sueño (GETRS) Clínica Las Condes, Santiago, Chile
| | - Jorge Jorquera
- Centro de Enfermedades Respiratorias y Grupo de Estudio Trastornos Respiratorios Del Sueño (GETRS) Clínica Las Condes, Santiago, Chile
| | - Ferran Barbe
- Respiratory Department. Hospital Univ Arnau de Vilanova, IRBLleida. and CIBERES, Madrid, Spain
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Abstract
Interest in telemedicine has increased exponentially. There is a growing body of published evidence on the use of telemedicine for patients using continuous positive airway pressure. Telemedicine-ready devices can support the transmission on use time, apnea-hypopnea index, and leakage. This approach enables early activation of troubleshooting. Automated, personalized feedback for patients and patient access to their own data provide unprecedented opportunities for integrating comanagement approaches, multiactor interactions, and patient empowerment. Telemedicine is likely cost effective, but requires better evidence. Notwithstanding barriers for implementation that remain, telemedicine has to be embraced, leaving the physician and patient to accept it or not.
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Affiliation(s)
- Johan Verbraecken
- Department of Pulmonary Medicine and Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, University of Antwerp, Drie Eikenstraat 655, Edegem, Antwerp 2650, Belgium.
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10
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Kooij L, Vos PJ, Dijkstra A, Roovers EA, van Harten WH. Video Consultation as an Adequate Alternative to Face-to-Face Consultation in Continuous Positive Airway Pressure Use for Newly Diagnosed Patients With Obstructive Sleep Apnea: Randomized Controlled Trial. JMIR Form Res 2021; 5:e20779. [PMID: 33973866 PMCID: PMC8150406 DOI: 10.2196/20779] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 10/25/2020] [Accepted: 04/13/2021] [Indexed: 01/29/2023] Open
Abstract
Background The effectiveness of continuous positive airway pressure (CPAP) is dependent on the degree of use, so adherence is essential. Cognitive components (eg, self-efficacy) and support during treatment have been found to be important in CPAP use. Video consultation may be useful to support patients during treatment. So far, video consultation has rarely been evaluated in thorough controlled research, with only a limited number of outcomes assessed. Objective The aim of the study was to evaluate the superiority of video consultation over face-to-face consultation for patients with obstructive sleep apnea (OSA) on CPAP use (minutes per night), adherence, self-efficacy, risk outcomes, outcome expectancies, expectations and experiences with video consultation, and satisfaction of patients and nurses. Methods A randomized controlled trial was conducted with an intervention (video consultation) and a usual care group (face-to-face consultation). Patients with confirmed OSA (apnea-hypopnea index >15), requiring CPAP treatment, no history of CPAP treatment, having access to a tablet or smartphone, and proficient in the Dutch language were recruited from a large teaching hospital. CPAP use was monitored remotely, with short-term (weeks 1 to 4) and long-term (week 4, week 12, and week 24) assessments. Questionnaires were completed at baseline and after 4 weeks on self-efficacy, risk perception, outcome expectancies (Self-Efficacy Measure for Sleep Apnea), expectations and experiences with video consultation (covering constructs of the unified theory of acceptance and use of technology), and satisfaction. Nurse satisfaction was evaluated using questionnaires. Results A total of 140 patients were randomized (1:1 allocation). The use of video consultation for OSA patients does not lead to superior results on CPAP use and adherence compared with face-to-face consultation. A significant difference in change over time was found between groups for short-term (P-interaction=.008) but not long-term (P-interaction=.68) CPAP use. CPAP use decreased in the long term (P=.008), but no significant difference was found between groups (P=.09). Change over time for adherence was not significantly different in the short term (P-interaction=.17) or long term (P-interaction=.51). A relation was found between CPAP use and self-efficacy (P=.001), regardless of the intervention arm (P=.25). No significant difference between groups was found for outcome expectancies (P=.64), self-efficacy (P=.41), and risk perception (P=.30). The experiences were positive, and 95% (60/63) intended to keep using video consultation. Patients in both groups rated the consultations on average with an 8.4. Overall, nurses (n=3) were satisfied with the video consultation system. Conclusions Support of OSA patients with video consultation does not lead to superior results on CPAP use and adherence compared with face-to-face consultation. The findings of this research suggest that self-efficacy is an important factor in improving CPAP use and that video consultation may be a feasible way to support patients starting CPAP. Future research should focus on blended care approaches in which self-efficacy receives greater emphasis. Trial Registration Clinicaltrials.gov NCT04563169; https://clinicaltrials.gov/show/NCT04563169
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Affiliation(s)
- Laura Kooij
- Rijnstate, Arnhem, Netherlands.,Department of Health Technology and Services Research, University of Twente, Enschede, Netherlands
| | - Petra Je Vos
- Pulmonary Department, Rijnstate, Arnhem, Netherlands
| | | | | | - Wim H van Harten
- Rijnstate, Arnhem, Netherlands.,Department of Health Technology and Services Research, University of Twente, Enschede, Netherlands.,Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, Netherlands
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11
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Hu Y, Su Y, Hu S, Ma J, Zhang Z, Fang F, Guan J. Effects of telemedicine interventions in improving continuous positive airway pressure adherence in patients with obstructive sleep apnoea: a meta-analysis of randomised controlled trials. Sleep Breath 2021; 25:1761-1771. [PMID: 33694034 DOI: 10.1007/s11325-021-02292-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 01/03/2021] [Accepted: 01/05/2021] [Indexed: 01/25/2023]
Abstract
PURPOSE This meta-analysis was conducted to assess the effects of telemedicine interventions on continuous positive airway pressure (CPAP) adherence in patients with obstructive sleep apnoea (OSA). METHODS The PubMed, Cochrane Library, OVID, Web of Science and EBSCO host databases were searched from January 2004 to February 2020 for randomised controlled trials (RCTs) that assessed the effects of telemedicine interventions on CPAP adherence in patients with OSA. The study inclusion criteria were RCTs that compared patients who received telemedicine interventions with a control group and reported a change in CPAP adherence. The primary outcome was the improvement in CPAP adherence. RESULTS In total, there were 11 RCTs (n = 1358) with quantitative analyses. Intervention times ranged from 1 to 6 months. Compared to controls, the telemedicine group exhibited better adherence to CPAP therapy (pooled mean difference (MD) = 0.57, 95% CI = 0.33 to 0.80, I2 = 7%, p < 0.00001). We performed sensitivity analyses by the type of telemedicine intervention, comorbidity burden, and OSA severity to explore whether or not their effect sizes may have affected the time of CPAP application. We performed subgroup analyses by follow-up duration, age, and OSA Epworth sleepiness scale (ESS) symptoms to determine if their effect sizes may have affected the time of CPAP application. However, these analyses did not change the statistical significance of the pooled estimate. CONCLUSIONS The use of telemedicine for up to 6 months may enhance CPAP adherence in patients with OSA, when compared to no intervention. Our study was searched from January 2004 to February 2020 for randomised controlled trials (RCTs) that assessed the effects of telemedicine interventions on CPAP adherence in patients with OSA. Future studies can continue to search for articles after February 2020.
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Affiliation(s)
- Yuli Hu
- Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Department of Otolaryngology Head and Neck Surgery & Center of Sle-ep Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Yishan Road 600, Shanghai, 200233, China.,Otolaryngological Institute of Shanghai Jiao Tong University, Yishan Road 600, Shanghai, 200233, China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Yishan Road 600, Shanghai, 200233, China
| | - Yijia Su
- Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Sanlian Hu
- Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
| | - Jun Ma
- Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Zuoyan Zhang
- Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Fang Fang
- Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China. .,Department of Otolaryngology Head and Neck Surgery & Center of Sle-ep Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Yishan Road 600, Shanghai, 200233, China. .,Otolaryngological Institute of Shanghai Jiao Tong University, Yishan Road 600, Shanghai, 200233, China. .,Shanghai Key Laboratory of Sleep Disordered Breathing, Yishan Road 600, Shanghai, 200233, China.
| | - Jian Guan
- Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Department of Otolaryngology Head and Neck Surgery & Center of Sle-ep Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Yishan Road 600, Shanghai, 200233, China.,Otolaryngological Institute of Shanghai Jiao Tong University, Yishan Road 600, Shanghai, 200233, China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Yishan Road 600, Shanghai, 200233, China
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12
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Abstract
The current standard in healthcare research is to maintain scientific fidelity of any intervention being tested. Fidelity is defined as the consistent delivery of interventions that ensures that all participants are provided the same information, guidance, and/or materials. Notably, the methods for ensuring fidelity of intervention delivery must also be consistent. This article describes our Intervention and Technology Delivery Fidelity Checklists used to ensure consistency. These checklists were completed by trained nurse observers who rated the intervention implementation and the technology delivery. Across our clinical trials and pilot studies, the fidelity scores were tabulated and compared. Intervention information and materials were delivered by a variety of devices including telehealth monitors, videophones, and/or iPads. Each of the devices allows audiovisual connections between health professionals from their offices and patients and participants in their homes. Our checklists guide the monitoring of fidelity of technology delivery. Overall checklist ratings across our studies demonstrate consistent intervention, implementation, and technology delivery approaches. Uniquely, the fidelity checklist verifies the interventionist's correct use of the technology devices to ensure consistent audiovisual delivery. Checklist methods to ensure intervention fidelity and technology delivery are essential research procedures, which can be adapted for use by researchers across multiple disciplines.
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Abstract
Obstructive sleep apnea (OSA) telehealth management may improve initial and chronic care access, time to diagnosis and treatment, between-visit care, e-communications and e-education, workflows, costs, and therapy outcomes. OSA telehealth options may be used to replace or supplement none, some, or all steps in the evaluation, testing, treatments, and management of OSA. All telehealth steps must adhere to OSA guidelines. OSA telehealth may be adapted for continuous positive airway pressure (CPAP) and non-CPAP treatments. E-data collection enhances uses for individual and group analytics, phenotyping, testing and treatment selections, high-risk identification and targeted support, and comparative and multispecialty therapy studies.
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14
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Askland K, Wright L, Wozniak DR, Emmanuel T, Caston J, Smith I. Educational, supportive and behavioural interventions to improve usage of continuous positive airway pressure machines in adults with obstructive sleep apnoea. Cochrane Database Syst Rev 2020; 4:CD007736. [PMID: 32255210 PMCID: PMC7137251 DOI: 10.1002/14651858.cd007736.pub3] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Although highly effective in the treatment of obstructive sleep apnoea (OSA), continuous positive airway pressure (CPAP) is not universally accepted by users. Educational, supportive and behavioural interventions may help people with OSA initiate and maintain regular and continued use of CPAP. OBJECTIVES To assess the effectiveness of educational, supportive, behavioural, or mixed (combination of two or more intervention types) strategies that aim to encourage adults who have been prescribed CPAP to use their devices. SEARCH METHODS Searches were conducted on the Cochrane Airways Group Specialised Register of trials. Searches are current to 29 April 2019. SELECTION CRITERIA We included randomised controlled trials (RCTs) that assessed intervention(s) designed to inform participants about CPAP/OSA, to support them in using CPAP, or to modify their behaviour to increase use of CPAP devices. DATA COLLECTION AND ANALYSIS We assessed studies to determine their suitability for inclusion in the review. Data were extracted independently and were entered into RevMan for analysis. 'Risk of bias' assessments were performed, using the updated 'Risk of bias 2' tool, for the primary outcome, CPAP usage. Study-level 'Risk of bias' assessments were performed using the original 'Risk of bias' tool. GRADE assessment was performed using GRADEpro. MAIN RESULTS Forty-one studies (9005 participants) are included in this review; 16 of these studies are newly identified with updated searches. Baseline Epworth Sleepiness Scale (ESS) scores indicate that most participants suffered from excessive daytime sleepiness. The majority of recruited participants had not used CPAP previously. When examining risk of bias for the primary outcome of hourly machine usage/night, 58.3% studies have high overall risk (24/41 studies), 39.0% have some concerns (16/41 studies), and 2.4% have low overall risk (1/41 studies). We are uncertain whether educational interventions improve device usage, as the certainty of evidence was assessed as very low. We were unable to perform meta-analyses for number of withdrawals and symptom scores due to high study heterogeneity. Supportive interventions probably increase device usage by 0.70 hours/night (95% confidence interval (CI) 0.36 to 1.05, N = 1426, 13 studies, moderate-certainty evidence), and low-certainty evidence indicates that the number of participants who used their devices ≥ 4 hours/night may increase from 601 to 717 per 1000 (odds ratio (OR), 1.68, 95% CI 1.08 to 2.60, N = 376, 2 studies). However, the number of withdrawals may also increase from 136 to 167 per 1000 (OR 1.27, 95% CI 0.97 to 1.66, N = 1702, 11 studies, low-certainty evidence). Participants may experience small improvements in symptoms (ESS score -0.32 points, 95% CI -1.19 to 0.56, N = 470, 5 studies, low-certainty evidence), and we are uncertain whether quality of life improves with supportive interventions, as the certainty of evidence was assessed as very low. When compared with usual care, behavioural interventions produce a clinically-meaningful increase in device usage by 1.31 hours/night (95% CI 0.95 to 1.66, N = 578, 8 studies, high-certainty evidence), probably increase the number of participants who used their machines ≥ 4 hours/night from 371 to 501 per 1000 (OR 1.70, 95% CI 1.20 to 2.41, N = 549, 6 studies, high-certainty evidence), and reduce the number of study withdrawals from 146 to 101 per 1000 (OR 0.66, 95% CI 0.44 to 0.98, N = 939, 10 studies, high-certainty evidence). Behavioural interventions may reduce symptoms (ESS score -2.42 points, 95% CI -4.27 to -0.57, N = 272, 5 studies, low-certainty evidence), but probably have no effect on quality of life (Functional Outcomes of Sleep Questionnaire (FOSQ), standardised mean difference (SMD) 0.00, 0.95% CI -0.26 to 0.26, N = 228, 3 studies, moderate-certainty evidence). We are uncertain whether behavioural interventions improve apnoea hypopnoea index (AHI), as the certainty of evidence was assessed as very low. We are uncertain if mixed interventions improve device usage, increase the number of participants using their machines ≥ 4 hours/night, reduce study withdrawals, improve quality of life, or reduce anxiety symptoms, as the certainty of evidence for these outcomes was assessed to be very low. Symptom scores via the ESS could not be measured due to considerable heterogeneity between studies. AUTHORS' CONCLUSIONS In CPAP-naïve people with OSA, high-certainty evidence indicates that behavioural interventions yield a clinically-significant increase in hourly device usage when compared with usual care. Moderate certainty evidence shows that supportive interventions increase usage modestly. Very low-certainty evidence shows that educational and mixed interventions may modestly increase CPAP usage. The impact of improved CPAP usage on daytime sleepiness, quality of life, and mood and anxiety scores remains unclear since these outcomes were not assessed in the majority of included studies. Studies addressing the choice of interventions that best match individual patient needs and therefore result in the most successful and cost-effective therapy are needed.
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Affiliation(s)
- Kathleen Askland
- Waypoint Centre for Mental Health CareWaypoint Research InstitutePenetanguisheneCanada
| | - Lauren Wright
- Waypoint Centre for Mental Health CareWaypoint Research InstitutePenetanguisheneCanada
- AstraZeneca Canada Inc.MississaugaOntarioCanada
| | - Dariusz R Wozniak
- Royal Papworth HospitalRespiratory Support and Sleep CentrePapworth EverardCambridgeUKCB23 3RE
| | - Talia Emmanuel
- Waypoint Centre for Mental Health CareWaypoint Research InstitutePenetanguisheneCanada
| | - Jessica Caston
- Waypoint Centre for Mental Health CareWaypoint Research InstitutePenetanguisheneCanada
| | - Ian Smith
- Royal Papworth HospitalRespiratory Support and Sleep CentrePapworth EverardCambridgeUKCB23 3RE
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15
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Bruyneel M. Telemedicine in the diagnosis and treatment of sleep apnoea. Eur Respir Rev 2019; 28:180093. [PMID: 30872397 PMCID: PMC9488740 DOI: 10.1183/16000617.0093-2018] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Accepted: 01/23/2019] [Indexed: 11/05/2022] Open
Abstract
Telemedicine (TM) is a current tool in the landscape of medicine. It helps to address public health challenges such as increases in chronic disease in an ageing society and the associated burden in healthcare costs. Sleep TM refers to patient data exchange with the purpose of enhancing disease management. Obstructive sleep apnoea (OSA) syndrome is a chronic disorder associated with a significant morbidity, mainly cardiometabolic, and mortality. Obtaining adequate compliance to continuous positive airway pressure (CPAP) remains the greatest challenge related to OSA treatment, and the adoption of TM to support OSA management makes sense. In addition, the prevalence of OSA is growing and OSA is associated with increased healthcare costs that could be streamlined by the application of TM. In OSA, multiple modalities of TM are utilised, such as telediagnostics, teleconsultation, teletherapy and telemonitoring of patients being treated with CPAP. In the present article, I aim to provide an overview of current practice and the recent developments in TM for OSA management. Concerns related to TM use will also be addressed.
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Affiliation(s)
- Marie Bruyneel
- Dept of Pneumology, CHU Saint Pierre, Université Libre de Bruxelles, Brussels, Belgium
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16
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Mehrtash M, Bakker JP, Ayas N. Predictors of Continuous Positive Airway Pressure Adherence in Patients with Obstructive Sleep Apnea. Lung 2019; 197:115-121. [PMID: 30617618 DOI: 10.1007/s00408-018-00193-1] [Citation(s) in RCA: 119] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 12/29/2018] [Indexed: 01/23/2023]
Abstract
Obstructive sleep apnea (OSA) is a common disease which impacts quality of life, mood, cardiovascular morbidity, and mortality. Continuous positive airway pressure (CPAP) is the first-line treatment for patients with moderate to severe OSA. CPAP ameliorates respiratory disturbances, leading to improvements in daytime sleepiness, quality of life, blood pressure, and cognition. However, despite the high efficacy of this device, CPAP adherence is often sub-optimal. Factors including: socio-demographic/economic characteristics, disease severity, psychological factors, and side-effects are thought to affect CPAP adherence in OSA patients. Intervention studies have suggested that augmented support/education, behavioral therapy, telemedicine and technological interventions may improve CPAP adherence. In this paper, we will extensively review the most common factors including age, gender, race/ethnicity, socioeconomic status, smoking status, severity of OSA, severity of OSA symptoms, psychological variables, social support, marital status/bed partner involvement, dry nose and mouth, mask leak, and nasal congestion that may predict CPAP adherence. We will also extensively review interventions that may increase adherence to CPAP.
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Affiliation(s)
- M Mehrtash
- Experimental Medicine Program, Department of Medicine, University of British Columbia (UBC), Vancouver, BC, Canada
- Sleep Disorders Program, UBC Hospital, Vancouver, BC, Canada
| | - J P Bakker
- Division of Sleep & Circadian Disorders, Brigham and Women's Hospital, Boston, MA, USA
| | - N Ayas
- Sleep Disorders Program, UBC Hospital, Vancouver, BC, Canada.
- Respiratory and Critical Care Divisions, Department of Medicine, UBC, Vancouver, BC, Canada.
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17
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Bros JS, Poulet C, Arnol N, Deschaux C, Gandit M, Charavel M. Acceptance of Telemonitoring Among Patients with Obstructive Sleep Apnea Syndrome: How is the Perceived Interest by and for Patients? Telemed J E Health 2018; 24:351-359. [DOI: 10.1089/tmj.2017.0134] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Julie S. Bros
- Laboratoire Inter-Universitaire de Psychologie (LIP/PC2S), University Grenoble Alpes, Grenoble, France
| | - Caroline Poulet
- Laboratoire Inter-Universitaire de Psychologie (LIP/PC2S), University Grenoble Alpes, Grenoble, France
| | | | | | - Marc Gandit
- Laboratoire Inter-Universitaire de Psychologie (LIP/PC2S), University Grenoble Alpes, Grenoble, France
| | - Marie Charavel
- Laboratoire Inter-Universitaire de Psychologie (LIP/PC2S), University Grenoble Alpes, Grenoble, France
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18
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Murphie P, Little S, McKinstry B, Pinnock H. Remote consulting with telemonitoring of continuous positive airway pressure usage data for the routine review of people with obstructive sleep apnoea hypopnoea syndrome: A systematic review. J Telemed Telecare 2017; 25:17-25. [PMID: 28990455 DOI: 10.1177/1357633x17735618] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Telehealth has the potential to offer more convenient care and reduce travel. We aimed to systematically review studies that assessed the effectiveness of teleconsultation plus telemonitoring in the review of people with obstructive sleep apnoea hypopnoea syndrome receiving continuous positive airway pressure therapy versus face-to-face care. METHODS Following Cochrane methodology, we searched 10 electronic databases (November 2015), trial registries, and reference lists of included studies, for trials testing interventions that combined remote consultations with telemonitoring of usage/continuous positive airway pressure data. Outcomes measures were: proportion reviewed, continuous positive airway pressure adherence, symptom control, and satisfaction/acceptability and cost effectiveness. RESULTS From 362 potentially relevant papers, we identified five randomised controlled trials ( n = 269 patients): four from North America and one from Spain. Risk of bias was moderate in one, and moderate/high in four trials. Two trials reported number/duration of reviews with inconsistent results. The teleconsultation/telemonitoring improved continuous positive airway pressure adherence in two trials ( n = 19; n = 75); two ( n = 114 and n = 75) reported no between-groups differences. Two studies, both at moderate/high risk of bias, showed no between-group difference in the Epworth Sleepiness Score. Satisfaction was generally reported positively in all five trials; one trial reported that the teleconsultation/telemonitoring patients were 'more likely to continue' with continuous positive airway pressure therapy treatment. One study reported teleconsultation/telemonitoring as cost effective. DISCUSSION The evidence for teleconsultation/telemonitoring in continuous positive airway pressure users is limited; however, no safety concerns have been raised. Adequately powered, well-designed trials are needed to establish whether real-time telemonitoring and remote teleconsultation is a clinically and cost effective option for people using continuous positive airway pressure therapy.
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Affiliation(s)
- Phyllis Murphie
- 1 Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, UK.,2 Department of Respiratory Medicine, NHS Dumfries and Galloway, UK
| | - Stuart Little
- 2 Department of Respiratory Medicine, NHS Dumfries and Galloway, UK
| | - Brian McKinstry
- 1 Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, UK
| | - Hilary Pinnock
- 1 Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, UK
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19
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Lugo V, Villanueva JA, Garmendia O, Montserrat JM. The role of telemedicine in obstructive sleep apnea management. Expert Rev Respir Med 2017. [DOI: 10.1080/17476348.2017.1343147] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Vera Lugo
- Unitat del Son Servei de Pneumologia, Hospital Clínic, Barcelona, Spain
| | - Jair Asir Villanueva
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain
| | - Onintza Garmendia
- Unitat del Son Servei de Pneumologia, Hospital Clínic, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Josep M. Montserrat
- Unitat del Son Servei de Pneumologia, Hospital Clínic, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain
- Institut d’investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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20
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Turino C, de Batlle J, Woehrle H, Mayoral A, Castro-Grattoni AL, Gómez S, Dalmases M, Sánchez-de-la-Torre M, Barbé F. Management of continuous positive airway pressure treatment compliance using telemonitoring in obstructive sleep apnoea. Eur Respir J 2017; 49:49/2/1601128. [PMID: 28179438 DOI: 10.1183/13993003.01128-2016] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Continuous positive airway pressure (CPAP) is an effective treatment for obstructive sleep apnoea (OSA), but treatment compliance is often unsatisfactory. This study investigated the efficacy and cost-effectiveness of telemonitoring for improving CPAP compliance.100 newly diagnosed OSA patients requiring CPAP (apnoea-hypopnoea index >15 events·h-1) were randomised to standard management or a telemonitoring programme that collected daily information about compliance, air leaks and residual respiratory events, and initiated patient contact to resolve issues. Clinical/anthropometric variables, daytime sleepiness and quality of life were recorded at baseline and after 3 months. Patient satisfaction, additional visits/calls, side-effects and total costs were assessed.There were no significant differences between the standard and telemedicine groups in terms of CPAP compliance (4.9±2.2 versus 5.1±2.1 h·night-1), symptoms, clinical variables, quality of life and unwanted effects. Telemedicine was less expensive than standard management (EUR123.65 versus EUR170.97; p=0.022) and was cost-effective (incremental cost-effectiveness ratio EUR17 358.65 per quality-adjusted life-year gained). Overall patient satisfaction was high, but significantly more patients rated satisfaction as high/very high in the standard management versus telemedicine group (96% versus 74%; p=0.034).Telemonitoring did not improve CPAP treatment compliance and was associated with lower patient satisfaction. However, it was more cost-effective than traditional follow-up.
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Affiliation(s)
- Cecilia Turino
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain.,These authors are joint first authors and contributed equally to this work
| | - Jordi de Batlle
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain.,These authors are joint first authors and contributed equally to this work
| | - Holger Woehrle
- Sleep and Ventilation Centre Blaubeuren, Respiratory Centre Ulm, Ulm, Germany.,ResMed Science Centre, ResMed Germany, Martinsried, Germany
| | | | - Anabel Lourdes Castro-Grattoni
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain
| | - Sílvia Gómez
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain
| | - Mireia Dalmases
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain
| | - Manuel Sánchez-de-la-Torre
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain .,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Ferran Barbé
- Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
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21
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Woehrle H, Ficker JH, Graml A, Fietze I, Young P, Teschler H, Arzt M. Telemedicine-based proactive patient management during positive airway pressure therapy: Impact on therapy termination rate. SOMNOLOGIE 2017; 21:121-127. [PMID: 28706464 PMCID: PMC5486580 DOI: 10.1007/s11818-016-0098-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 12/16/2016] [Indexed: 12/02/2022]
Abstract
Background Adherence to positive airway pressure (PAP) therapy is essential for the benefits of therapy to be realised. Telemedicine-based strategies provide a new option for enhanced monitoring and intervention to promote adherence during PAP. This study investigated the impact of telemedicine-based proactive patient management on PAP therapy termination rates versus standard care. Methods Observational data were obtained from ResMed Germany Healthcare, a German homecare provider. Patients were undergoing routine homecare using either a standard or proactive management strategy. The proactive strategy used data from AirView™, a cloud-based remote monitoring system, to prompt patient contact and information sharing/education. Patients receiving their first PAP therapy were included and analysed in matched pairs. Results In all, 3401 patients were included in each group. In the first year of PAP therapy, overall therapy termination rate was significantly lower (5.4% vs 11.0%; p < 0.001) and time to therapy termination was significantly longer (348 ± 58 vs 337 ± 76 days; p < 0.05) in the proactive versus standard care group. Cox proportional hazard analysis revealed a significantly reduced risk of PAP termination in the proactive versus the standard care group (hazard ratio 0.48, 95% confidence interval 0.4–0.57). Findings were consistent in subanalyses according to gender, type of device and insurance status, and in patients aged ≥40 years. However, in the subgroup of patients aged younger than 40 years, the risk of PAP termination was similar in the proactive and standard groups. Conclusion A telemedicine-based proactive management strategy compared with standard care of PAP patients was associated with a lower long-term therapy termination rate.
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Affiliation(s)
- Holger Woehrle
- Sleep and Ventilation Center Blaubeuren, Respiratory Center Ulm, Olgastr. 83, 89073 Ulm, Germany
- ResMed Science Center, ResMed Germany, Martinsried, Germany
| | - Joachim H. Ficker
- Department of Respiratory Medicine, Allergology and Sleep Medicine, General Hospital Nuremberg, Nuremberg, Germany
- Paracelsus Medical University, Nuremberg, Germany
| | - Andrea Graml
- ResMed Science Center, ResMed Germany, Martinsried, Germany
| | - Ingo Fietze
- Centrum für Herz-Kreislauf- und Gefäßmedizin, Interdisziplinäres Schlafmedizinisches Zentrum, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Peter Young
- Klinik für Schlafmedizin und Neuromuskuläre Erkrankungen, Universitätsklinikum Münster, Münster, Germany
| | - Helmut Teschler
- Department of Pneumology, Ruhrlandklinik, West German Lung Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Michael Arzt
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
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22
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Watson NF, Rosen IM, Chervin RD. The Past Is Prologue: The Future of Sleep Medicine. J Clin Sleep Med 2017; 13:127-135. [PMID: 27998380 DOI: 10.5664/jcsm.6406] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 11/16/2016] [Indexed: 12/17/2022]
Abstract
ABSTRACT The field of sleep medicine has gone through tremendous growth and development over a short period of time, culminating in recognition of the field as an independent medical subspecialty by the Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Medical Specialties (ABMS). However, the fellowship training requirement that is now mandatory for sleep medicine board certification eligibility has had the unintended consequence of restricting the influx of young physicians to the field. In response to the potential workforce shortage confronting the field of sleep medicine, the American Academy of Sleep Medicine (AASM) board of directors has developed a comprehensive plan to strengthen the field by growing sleep fellowship programs, exploring novel sleep medicine training opportunities, creating and fostering the sleep team (with special emphasis on engagement of primary care providers), embracing the role of consumer sleep technologies, and expanding the reach of sleep specialists through telemedicine. The AASM plans summarized in this special article represent efforts to confront serious workforce challenges and turn them into opportunities that will improve the health of both our patients and our field.
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23
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Hostler JM, Sheikh KL, Andrada TF, Khramtsov A, Holley PR, Holley AB. A mobile, web-based system can improve positive airway pressure adherence. J Sleep Res 2016; 26:139-146. [DOI: 10.1111/jsr.12476] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 10/12/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Jordanna M. Hostler
- Department of Pulmonary, Critical Care, and Sleep Medicine; Walter Reed National Military Medical Center (WRNMMC); Bethesda MD USA
| | | | - Teotimo F. Andrada
- Department of Pulmonary, Critical Care, and Sleep Medicine; Walter Reed National Military Medical Center (WRNMMC); Bethesda MD USA
| | - Andrei Khramtsov
- Department of Pulmonary, Critical Care, and Sleep Medicine; Walter Reed National Military Medical Center (WRNMMC); Bethesda MD USA
| | - Paul R. Holley
- Department of Informatics; US Army Medical Research Institute of Infectious Diseases; Frederick MD USA
| | - Aaron B. Holley
- Department of Pulmonary, Critical Care, and Sleep Medicine; Walter Reed National Military Medical Center (WRNMMC); Bethesda MD USA
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D’Rozario AL, Galgut Y, Bartlett DJ. An Update on Behavioural Interventions for Improving Adherence with Continuous Positive Airway Pressure in Adults. CURRENT SLEEP MEDICINE REPORTS 2016. [DOI: 10.1007/s40675-016-0051-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Isetta V, Torres M, González K, Ruiz C, Dalmases M, Embid C, Navajas D, Farré R, Montserrat JM. A New mHealth application to support treatment of sleep apnoea patients. J Telemed Telecare 2016; 23:14-18. [PMID: 26672606 DOI: 10.1177/1357633x15621848] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Continuous positive airway pressure (CPAP) is the first-choice treatment for obstructive sleep apnoea (OSA), but adherence is frequently suboptimal. Innovative, patient-centred interventions are, therefore, needed to enhance compliance. Due to its low cost and ubiquity, mobile health (mHealth) technology seems particularly suited for this purpose. We endeavoured to develop an mHealth application called "APPnea," aimed at promoting patient self-monitoring of CPAP treatment. We then assessed the feasibility and acceptability of APPnea in a group of OSA patients. Methods Consecutive OSA patients used APPnea for six weeks. APPnea gave patients daily reminders to answer three questions about their OSA treatment (CPAP use, physical activity, and diet) and prompted them to upload their body weight weekly. Answers were saved to a secure server for further analysis. After completing the study, patients gave their anonymous opinions about APPnea. Results We enrolled 60 patients with OSA receiving CPAP treatment. The mean age was 56 ± 10 years and the apnoea-hypopnea index was 47 ± 25 events/hour. In total, 63% of participants completed the daily questionnaire for more than 66% of the study period. Objective CPAP compliance was generally high (5.3 ± 1.6 hours/night). In a subset of 38 patients naïve to CPAP, those who used APPnea regularly had significantly higher CPAP compliance. Satisfaction levels were high for the majority of users. Conclusion This mHealth intervention is not only feasible but also satisfactory to patients. Although larger randomized trials and cost-effectiveness studies should be performed, this study shows that APPnea could promote participation and improve compliance among patients with OSA, thereby improving outcomes.
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Affiliation(s)
- Valentina Isetta
- 1 Unit of Biophysics and Bioengineering, Faculty of Medicine, University of Barcelona, Barcelona, Spain.,2 CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Marta Torres
- 2 CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain.,3 Sleep Laboratory, Pneumology Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Kevin González
- 1 Unit of Biophysics and Bioengineering, Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Concepción Ruiz
- 3 Sleep Laboratory, Pneumology Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Mireia Dalmases
- 2 CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain.,3 Sleep Laboratory, Pneumology Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Cristina Embid
- 2 CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain.,3 Sleep Laboratory, Pneumology Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Daniel Navajas
- 1 Unit of Biophysics and Bioengineering, Faculty of Medicine, University of Barcelona, Barcelona, Spain.,2 CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain.,4 Institute for Bioengineering of Catalonia (IBEC), Barcelona, Spain
| | - Ramon Farré
- 1 Unit of Biophysics and Bioengineering, Faculty of Medicine, University of Barcelona, Barcelona, Spain.,2 CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain.,5 Institut d'Investigacions Biomediques August Pi Sunyer (IDIBAPS), Barcelona, Spain
| | - Josep M Montserrat
- 2 CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain.,3 Sleep Laboratory, Pneumology Department, Hospital Clinic of Barcelona, Barcelona, Spain.,5 Institut d'Investigacions Biomediques August Pi Sunyer (IDIBAPS), Barcelona, Spain
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Anttalainen U, Melkko S, Hakko S, Laitinen T, Saaresranta T. Telemonitoring of CPAP therapy may save nursing time. Sleep Breath 2016; 20:1209-1215. [DOI: 10.1007/s11325-016-1337-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 03/04/2016] [Accepted: 03/28/2016] [Indexed: 11/28/2022]
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Zia S, Fields BG. Sleep Telemedicine: An Emerging Field's Latest Frontier. Chest 2016; 149:1556-65. [PMID: 26970035 DOI: 10.1016/j.chest.2016.02.670] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 01/18/2016] [Accepted: 02/26/2016] [Indexed: 12/01/2022] Open
Abstract
There is a widening gap between sleep provider access and patient demand for it. An American Academy of Sleep Medicine position paper recently recognized sleep telemedicine as one tool to narrow that divide. We define the term sleep telemedicine as the use of sleep-related medical information exchanged from one site to another via electronic communications to improve a patient's health. Applicable data transfer methods include telephone, video, smartphone applications, and the Internet. Their usefulness for the treatment of insomnia and sleep-disordered breathing is highlighted. Sleep telemedicine programs range in complexity from telephone-based patient feedback systems to comprehensive treatment pathways incorporating real-time video, telephone, and the Internet. While large, randomized trials are lacking, smaller studies comparing telemedicine with in-person care suggest noninferiority in terms of patient satisfaction, adherence to treatment, and symptomatic improvement. Sleep telemedicine is feasible from a technological and quality-driven perspective, but cost uncertainties, complex reimbursement structures, and variable licensing rules remain significant challenges to its feasibility on a larger scale. As legislative reform pends, larger randomized trials are needed to elucidate impact on patient outcomes, cost, and health-care system accessibility.
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Affiliation(s)
- Subaila Zia
- Emory Clinic Sleep Center, Emory University, Atlanta, GA
| | - Barry G Fields
- Department of Medicine, Emory University, Atlanta, GA; Atlanta Veterans Affairs Medical Center, Atlanta, GA.
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Fields BG, Behari PP, McCloskey S, True G, Richardson D, Thomasson A, Korom-Djakovic D, Davies K, Kuna ST. Remote Ambulatory Management of Veterans with Obstructive Sleep Apnea. Sleep 2016; 39:501-9. [PMID: 26446115 DOI: 10.5665/sleep.5514] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 09/12/2015] [Indexed: 01/09/2023] Open
Abstract
STUDY OBJECTIVES Despite significant medical sequelae of obstructive sleep apnea (OSA), the condition remains undiagnosed and untreated in many affected individuals. We explored the feasibility of a comprehensive, telemedicine-based OSA management pathway in a community-based Veteran cohort. METHODS This prospective, parallel-group randomized pilot study assessed feasibility of a telemedicine-based pathway for OSA evaluation and management in comparison to a more traditional, in-person care model. The study included 60 Veterans at the Philadelphia Veterans Affairs Medical Center and two affiliated community-based outpatient clinics. Telemedicine pathway feasibility, acceptability, and outcomes were assessed through a variety of quantitative (Functional Outcomes of Sleep Questionnaire, dropout rates, positive airway pressure [PAP] adherence rates, participant satisfaction ratings) and qualitative (verbal feedback) metrics. RESULTS There was no significant difference in functional outcome changes, patient satisfaction, dropout rates, or objectively measured PAP adherence between groups after 3 months of treatment. Telemedicine participants showed greater improvement in mental health scores, and their feedback was overwhelmingly positive. CONCLUSIONS Our pilot study suggests that telemedicine-based management of OSA patients is feasible in terms of patient functional outcomes and overall satisfaction with care. Future studies should include larger populations to further elucidate these findings while assessing provider- and patient-related cost effectiveness.
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Affiliation(s)
- Barry G Fields
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Emory University, Atlanta, GA.,Atlanta Veterans Affairs Medical Center, Decatur, GA
| | - Pratima Pathak Behari
- Philadelphia Veterans Affairs Medical Center, Philadelphia, PA.,Division of Sleep Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.,Center for Sleep and Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Susan McCloskey
- Philadelphia Veterans Affairs Medical Center, Philadelphia, PA
| | - Gala True
- Philadelphia Veterans Affairs Medical Center, Philadelphia, PA
| | | | - Arwin Thomasson
- Philadelphia Veterans Affairs Medical Center, Philadelphia, PA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Danijela Korom-Djakovic
- Philadelphia Veterans Affairs Medical Center, Philadelphia, PA.,Independent Researcher, Philadelphia, PA
| | - Keith Davies
- Philadelphia Veterans Affairs Medical Center, Philadelphia, PA
| | - Samuel T Kuna
- Philadelphia Veterans Affairs Medical Center, Philadelphia, PA.,Division of Sleep Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.,Center for Sleep and Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Flodgren G, Rachas A, Farmer AJ, Inzitari M, Shepperd S. Interactive telemedicine: effects on professional practice and health care outcomes. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2015. [PMID: 26343551 DOI: 10.1002/14651858.cd002098.pub2.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Telemedicine (TM) is the use of telecommunication systems to deliver health care at a distance. It has the potential to improve patient health outcomes, access to health care and reduce healthcare costs. As TM applications continue to evolve it is important to understand the impact TM might have on patients, healthcare professionals and the organisation of care. OBJECTIVES To assess the effectiveness, acceptability and costs of interactive TM as an alternative to, or in addition to, usual care (i.e. face-to-face care, or telephone consultation). SEARCH METHODS We searched the Effective Practice and Organisation of Care (EPOC) Group's specialised register, CENTRAL, MEDLINE, EMBASE, five other databases and two trials registers to June 2013, together with reference checking, citation searching, handsearching and contact with study authors to identify additional studies. SELECTION CRITERIA We considered randomised controlled trials of interactive TM that involved direct patient-provider interaction and was delivered in addition to, or substituting for, usual care compared with usual care alone, to participants with any clinical condition. We excluded telephone only interventions and wholly automatic self-management TM interventions. DATA COLLECTION AND ANALYSIS For each condition, we pooled outcome data that were sufficiently homogenous using fixed effect meta-analysis. We reported risk ratios (RR) and 95% confidence intervals (CI) for dichotomous outcomes, and mean differences (MD) for continuous outcomes. MAIN RESULTS We included 93 eligible trials (N = 22,047 participants), which evaluated the effectiveness of interactive TM delivered in addition to (32% of studies), as an alternative to (57% of studies), or partly substituted for usual care (11%) as compared to usual care alone.The included studies recruited patients with the following clinical conditions: cardiovascular disease (36), diabetes (21), respiratory conditions (9), mental health or substance abuse conditions (7), conditions requiring a specialist consultation (6), co morbidities (3), urogenital conditions (3), neurological injuries and conditions (2), gastrointestinal conditions (2), neonatal conditions requiring specialist care (2), solid organ transplantation (1), and cancer (1).Telemedicine provided remote monitoring (55 studies), or real-time video-conferencing (38 studies), which was used either alone or in combination. The main TM function varied depending on clinical condition, but fell typically into one of the following six categories, with some overlap: i) monitoring of a chronic condition to detect early signs of deterioration and prompt treatment and advice, (41); ii) provision of treatment or rehabilitation (12), for example the delivery of cognitive behavioural therapy, or incontinence training; iii) education and advice for self-management (23), for example nurses delivering education to patients with diabetes or providing support to parents of very low birth weight infants or to patients with home parenteral nutrition; iv) specialist consultations for diagnosis and treatment decisions (8), v) real-time assessment of clinical status, for example post-operative assessment after minor operation or follow-up after solid organ transplantation (8) vi), screening, for angina (1).The type of data transmitted by the patient, the frequency of data transfer, (e.g. telephone, e-mail, SMS) and frequency of interactions between patient and healthcare provider varied across studies, as did the type of healthcare provider/s and healthcare system involved in delivering the intervention.We found no difference between groups for all-cause mortality for patients with heart failure (16 studies; N = 5239; RR:0.89, 95% CI 0.76 to 1.03, P = 0.12; I(2) = 44%) (moderate to high certainty of evidence) at a median of six months follow-up. Admissions to hospital (11 studies; N = 4529) ranged from a decrease of 64% to an increase of 60% at median eight months follow-up (moderate certainty of evidence). We found some evidence of improved quality of life (five studies; N = 482; MD:-4.39, 95% CI -7.94 to -0.83; P < 0.02; I(2) = 0%) (moderate certainty of evidence) for those allocated to TM as compared with usual care at a median three months follow-up. In studies recruiting participants with diabetes (16 studies; N = 2768) we found lower glycated haemoglobin (HbA1c %) levels in those allocated to TM than in controls (MD -0.31, 95% CI -0.37 to -0.24; P < 0.00001; I(2)= 42%, P = 0.04) (high certainty of evidence) at a median of nine months follow-up. We found some evidence for a decrease in LDL (four studies, N = 1692; MD -12.45, 95% CI -14.23 to -10.68; P < 0.00001; I(2 =) 0%) (moderate certainty of evidence), and blood pressure (four studies, N = 1770: MD: SBP:-4.33, 95% CI -5.30 to -3.35, P < 0.00001; I(2) = 17%; DBP: -2.75 95% CI -3.28 to -2.22, P < 0.00001; I(2) = 45% (moderate certainty evidence), in TM as compared with usual care.Seven studies that recruited participants with different mental health and substance abuse problems, reported no differences in the effect of therapy delivered over video-conferencing, as compared to face-to-face delivery. Findings from the other studies were inconsistent; there was some evidence that monitoring via TM improved blood pressure control in participants with hypertension, and a few studies reported improved symptom scores for those with a respiratory condition. Studies recruiting participants requiring mental health services and those requiring specialist consultation for a dermatological condition reported no differences between groups. AUTHORS' CONCLUSIONS The findings in our review indicate that the use of TM in the management of heart failure appears to lead to similar health outcomes as face-to-face or telephone delivery of care; there is evidence that TM can improve the control of blood glucose in those with diabetes. The cost to a health service, and acceptability by patients and healthcare professionals, is not clear due to limited data reported for these outcomes. The effectiveness of TM may depend on a number of different factors, including those related to the study population e.g. the severity of the condition and the disease trajectory of the participants, the function of the intervention e.g., if it is used for monitoring a chronic condition, or to provide access to diagnostic services, as well as the healthcare provider and healthcare system involved in delivering the intervention.
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Affiliation(s)
- Gerd Flodgren
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Roosevelt Drive, Headington, Oxford, Oxfordshire, UK, OX3 7LF
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Flodgren G, Rachas A, Farmer AJ, Inzitari M, Shepperd S. Interactive telemedicine: effects on professional practice and health care outcomes. Cochrane Database Syst Rev 2015; 2015:CD002098. [PMID: 26343551 PMCID: PMC6473731 DOI: 10.1002/14651858.cd002098.pub2] [Citation(s) in RCA: 343] [Impact Index Per Article: 38.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Telemedicine (TM) is the use of telecommunication systems to deliver health care at a distance. It has the potential to improve patient health outcomes, access to health care and reduce healthcare costs. As TM applications continue to evolve it is important to understand the impact TM might have on patients, healthcare professionals and the organisation of care. OBJECTIVES To assess the effectiveness, acceptability and costs of interactive TM as an alternative to, or in addition to, usual care (i.e. face-to-face care, or telephone consultation). SEARCH METHODS We searched the Effective Practice and Organisation of Care (EPOC) Group's specialised register, CENTRAL, MEDLINE, EMBASE, five other databases and two trials registers to June 2013, together with reference checking, citation searching, handsearching and contact with study authors to identify additional studies. SELECTION CRITERIA We considered randomised controlled trials of interactive TM that involved direct patient-provider interaction and was delivered in addition to, or substituting for, usual care compared with usual care alone, to participants with any clinical condition. We excluded telephone only interventions and wholly automatic self-management TM interventions. DATA COLLECTION AND ANALYSIS For each condition, we pooled outcome data that were sufficiently homogenous using fixed effect meta-analysis. We reported risk ratios (RR) and 95% confidence intervals (CI) for dichotomous outcomes, and mean differences (MD) for continuous outcomes. MAIN RESULTS We included 93 eligible trials (N = 22,047 participants), which evaluated the effectiveness of interactive TM delivered in addition to (32% of studies), as an alternative to (57% of studies), or partly substituted for usual care (11%) as compared to usual care alone.The included studies recruited patients with the following clinical conditions: cardiovascular disease (36), diabetes (21), respiratory conditions (9), mental health or substance abuse conditions (7), conditions requiring a specialist consultation (6), co morbidities (3), urogenital conditions (3), neurological injuries and conditions (2), gastrointestinal conditions (2), neonatal conditions requiring specialist care (2), solid organ transplantation (1), and cancer (1).Telemedicine provided remote monitoring (55 studies), or real-time video-conferencing (38 studies), which was used either alone or in combination. The main TM function varied depending on clinical condition, but fell typically into one of the following six categories, with some overlap: i) monitoring of a chronic condition to detect early signs of deterioration and prompt treatment and advice, (41); ii) provision of treatment or rehabilitation (12), for example the delivery of cognitive behavioural therapy, or incontinence training; iii) education and advice for self-management (23), for example nurses delivering education to patients with diabetes or providing support to parents of very low birth weight infants or to patients with home parenteral nutrition; iv) specialist consultations for diagnosis and treatment decisions (8), v) real-time assessment of clinical status, for example post-operative assessment after minor operation or follow-up after solid organ transplantation (8) vi), screening, for angina (1).The type of data transmitted by the patient, the frequency of data transfer, (e.g. telephone, e-mail, SMS) and frequency of interactions between patient and healthcare provider varied across studies, as did the type of healthcare provider/s and healthcare system involved in delivering the intervention.We found no difference between groups for all-cause mortality for patients with heart failure (16 studies; N = 5239; RR:0.89, 95% CI 0.76 to 1.03, P = 0.12; I(2) = 44%) (moderate to high certainty of evidence) at a median of six months follow-up. Admissions to hospital (11 studies; N = 4529) ranged from a decrease of 64% to an increase of 60% at median eight months follow-up (moderate certainty of evidence). We found some evidence of improved quality of life (five studies; N = 482; MD:-4.39, 95% CI -7.94 to -0.83; P < 0.02; I(2) = 0%) (moderate certainty of evidence) for those allocated to TM as compared with usual care at a median three months follow-up. In studies recruiting participants with diabetes (16 studies; N = 2768) we found lower glycated haemoglobin (HbA1c %) levels in those allocated to TM than in controls (MD -0.31, 95% CI -0.37 to -0.24; P < 0.00001; I(2)= 42%, P = 0.04) (high certainty of evidence) at a median of nine months follow-up. We found some evidence for a decrease in LDL (four studies, N = 1692; MD -12.45, 95% CI -14.23 to -10.68; P < 0.00001; I(2 =) 0%) (moderate certainty of evidence), and blood pressure (four studies, N = 1770: MD: SBP:-4.33, 95% CI -5.30 to -3.35, P < 0.00001; I(2) = 17%; DBP: -2.75 95% CI -3.28 to -2.22, P < 0.00001; I(2) = 45% (moderate certainty evidence), in TM as compared with usual care.Seven studies that recruited participants with different mental health and substance abuse problems, reported no differences in the effect of therapy delivered over video-conferencing, as compared to face-to-face delivery. Findings from the other studies were inconsistent; there was some evidence that monitoring via TM improved blood pressure control in participants with hypertension, and a few studies reported improved symptom scores for those with a respiratory condition. Studies recruiting participants requiring mental health services and those requiring specialist consultation for a dermatological condition reported no differences between groups. AUTHORS' CONCLUSIONS The findings in our review indicate that the use of TM in the management of heart failure appears to lead to similar health outcomes as face-to-face or telephone delivery of care; there is evidence that TM can improve the control of blood glucose in those with diabetes. The cost to a health service, and acceptability by patients and healthcare professionals, is not clear due to limited data reported for these outcomes. The effectiveness of TM may depend on a number of different factors, including those related to the study population e.g. the severity of the condition and the disease trajectory of the participants, the function of the intervention e.g., if it is used for monitoring a chronic condition, or to provide access to diagnostic services, as well as the healthcare provider and healthcare system involved in delivering the intervention.
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Affiliation(s)
- Gerd Flodgren
- Norwegian Institute of Public HealthThe Norwegian Knowledge Centre for the Health ServicesPilestredet Park 7OsloNorway0176
| | - Antoine Rachas
- European Hospital Georges Pompidou and Paris Descartes UniversityDepartment of IT and Public Health20‐40 Rue leBlancParisFrance75908
| | - Andrew J Farmer
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory Quarter, Walton StreetOxfordUKOX2 6GG
| | - Marco Inzitari
- Parc Sanitari Pere Virgili and Universitat Autònoma de BarcelonaDepartment of Healthcare/Medicinec Esteve Terrades 30BarcelonaSpain08023
| | - Sasha Shepperd
- University of OxfordNuffield Department of Population HealthRosemary Rue Building, Old Road CampusHeadingtonOxfordOxfordshireUKOX3 7LF
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Isetta V, Negrín MA, Monasterio C, Masa JF, Feu N, Álvarez A, Campos-Rodriguez F, Ruiz C, Abad J, Vázquez-Polo FJ, Farré R, Galdeano M, Lloberes P, Embid C, de la Peña M, Puertas J, Dalmases M, Salord N, Corral J, Jurado B, León C, Egea C, Muñoz A, Parra O, Cambrodi R, Martel-Escobar M, Arqué M, Montserrat JM. A Bayesian cost-effectiveness analysis of a telemedicine-based strategy for the management of sleep apnoea: a multicentre randomised controlled trial. Thorax 2015; 70:1054-61. [PMID: 26310452 DOI: 10.1136/thoraxjnl-2015-207032] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 07/28/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND Compliance with continuous positive airway pressure (CPAP) therapy is essential in patients with obstructive sleep apnoea (OSA), but adequate control is not always possible. This is clinically important because CPAP can reverse the morbidity and mortality associated with OSA. Telemedicine, with support provided via a web platform and video conferences, could represent a cost-effective alternative to standard care management. AIM To assess the telemedicine impact on treatment compliance, cost-effectiveness and improvement in quality of life (QoL) when compared with traditional face-to-face follow-up. METHODS A randomised controlled trial was performed to compare a telemedicine-based CPAP follow-up strategy with standard face-to-face management. Consecutive OSA patients requiring CPAP treatment, with sufficient internet skills and who agreed to participate, were enrolled. They were followed-up at 1, 3 and 6 months and answered surveys about sleep, CPAP side effects and lifestyle. We compared CPAP compliance, cost-effectiveness and QoL between the beginning and the end of the study. A Bayesian cost-effectiveness analysis with non-informative priors was performed. RESULTS We randomised 139 patients. At 6 months, we found similar levels of CPAP compliance, and improved daytime sleepiness, QoL, side effects and degree of satisfaction in both groups. Despite requiring more visits, the telemedicine group was more cost-effective: costs were lower and differences in effectiveness were not relevant. CONCLUSIONS A telemedicine-based strategy for the follow-up of CPAP treatment in patients with OSA was as effective as standard hospital-based care in terms of CPAP compliance and symptom improvement, with comparable side effects and satisfaction rates. The telemedicine-based strategy had lower total costs due to savings on transport and less lost productivity (indirect costs). TRIAL REGISTER NUMBER NCT01716676.
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Affiliation(s)
- Valentina Isetta
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Miguel A Negrín
- Departamento de Métodos Cuantitativos y TiDES Institute, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Islas Canarias, Spain
| | - Carmen Monasterio
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain Unidad del Sueño, Servicio de Neumología, Hospital Universitario de Bellvitge, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
| | - Juan F Masa
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain Servicio de Neumología, Hospital San Pedro de Alcántara, Cáceres, Spain
| | - Nuria Feu
- Unidad del Sueño, Hospital Universitario Reina Sofía, Universidad de Córdoba, IMIBIC, Córdoba, Spain
| | - Ainhoa Álvarez
- Unidad Funcional de Sueño, Hospital Universitario Araba, Vitoria-Gasteiz, Spain
| | | | - Concepción Ruiz
- Servicio de Neumología, Unidad del Sueño, Hospital Clínic de Barcelona, Universidad de Barcelona, Barcelona, Spain
| | - Jorge Abad
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain Servicio de Neumología, Hospital Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, Spain
| | - Francisco J Vázquez-Polo
- Departamento de Métodos Cuantitativos y TiDES Institute, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Islas Canarias, Spain
| | - Ramon Farré
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Marina Galdeano
- Servicio de Neumología, Hospital Universitario Sagrat Cor, Universidad de Barcelona, Barcelona, Spain
| | - Patricia Lloberes
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain Servicio de Neumología, Unidad del Sueño, Hospital Universitario Vall d´Hebron, Barcelona, Spain
| | - Cristina Embid
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain Servicio de Neumología, Unidad del Sueño, Hospital Clínic de Barcelona, Universidad de Barcelona, Barcelona, Spain
| | - Mónica de la Peña
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain Servicio de Neumología, Hospital Universitario Son Espases, IdisPa, Palma de Mallorca, Spain
| | - Javier Puertas
- Departamento de Neurofisiología Clínica y Unidad del Sueño, Hospital Universitario La Ribera, Alzira, Valencia, Spain Departamento de Fisiología, Universidad de Valencia, Valencia, Spain
| | - Mireia Dalmases
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain Servicio de Neumología, Unidad del Sueño, Hospital Clínic de Barcelona, Universidad de Barcelona, Barcelona, Spain
| | - Neus Salord
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain Unidad del Sueño, Servicio de Neumología, Hospital Universitario de Bellvitge, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
| | - Jaime Corral
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain Servicio de Neumología, Hospital San Pedro de Alcántara, Cáceres, Spain
| | - Bernabé Jurado
- Unidad del Sueño, Hospital Universitario Reina Sofía, Universidad de Córdoba, IMIBIC, Córdoba, Spain
| | - Carmen León
- Servicio de Neumología, Unidad del Sueño, Hospital Clínic de Barcelona, Universidad de Barcelona, Barcelona, Spain
| | - Carlos Egea
- Unidad Funcional de Sueño, Hospital Universitario Araba, Vitoria-Gasteiz, Spain
| | - Aida Muñoz
- Servicio de Neumología, Hospital Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, Spain
| | - Olga Parra
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain Servicio de Neumología, Hospital Universitario Sagrat Cor, Universidad de Barcelona, Barcelona, Spain
| | - Roser Cambrodi
- Servicio de Neumología, Unidad del Sueño, Hospital Universitario Vall d´Hebron, Barcelona, Spain
| | - María Martel-Escobar
- Departamento de Métodos Cuantitativos y TiDES Institute, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Islas Canarias, Spain
| | - Meritxell Arqué
- Servicio de Neumología, Hospital Universitario Son Espases, IdisPa, Palma de Mallorca, Spain
| | - Josep M Montserrat
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain Servicio de Neumología, Unidad del Sueño, Hospital Clínic de Barcelona, Universidad de Barcelona, Barcelona, Spain
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Lal C, White DR, Joseph JE, van Bakergem K, LaRosa A. Sleep-Disordered Breathing in Down Syndrome. Chest 2015; 147:570-579. [PMID: 25644910 DOI: 10.1378/chest.14-0266] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Chitra Lal
- Department of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Medical University of South Carolina, Charleston, SC.
| | - David R White
- Department of Pediatric Otolaryngology, Medical University of South Carolina, Charleston, SC
| | - Jane E Joseph
- Department of Neurosciences, Medical University of South Carolina, Charleston, SC
| | - Karen van Bakergem
- Department of Pediatrics, Division of Developmental-Behavioral Pediatrics, Medical University of South Carolina, Charleston, SC
| | - Angela LaRosa
- Department of Pediatrics, Division of Developmental-Behavioral Pediatrics, Medical University of South Carolina, Charleston, SC
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Lai AYK, Fong DYT, Lam JCM, Weaver TE, Ip MSM. The efficacy of a brief motivational enhancement education program on CPAP adherence in OSA: a randomized controlled trial. Chest 2015; 146:600-610. [PMID: 24810282 DOI: 10.1378/chest.13-2228] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Poor adherence to CPAP treatment in OSA adversely affects the effectiveness of this therapy. This randomized controlled trial (RCT) examined the efficacy of a brief motivational enhancement education program in improving adherence to CPAP treatment in subjects with OSA. METHODS Subjects with newly diagnosed OSA were recruited into this RCT. The control group received usual advice on the importance of CPAP therapy and its care. The intervention group received usual care plus a brief motivational enhancement education program directed at enhancing the subjects' knowledge, motivation, and self-efficacy to use CPAP through the use of a 25-min video, a 20-min patient-centered interview, and a 10-min telephone follow-up. Self-reported daytime sleepiness adherence-related cognitions and quality of life were assessed at 1 month and 3 months. CPAP usage data were downloaded at the completion of this 3-month study. RESULTS One hundred subjects with OSA (mean ± SD, age 52 ± 10 years; Epworth Sleepiness Scales [ESS], 9 ± 5; median [interquartile range] apnea-hypopnea index, 29 [20, 53] events/h) prescribed CPAP treatment were recruited. The intervention group had better CPAP use (higher daily CPAP usage by 2 h/d [Cohen d = 1.33, P < .001], a fourfold increase in the number using CPAP for ≥ 70% of days with ≥ 4 h/d [P < .001]), and greater improvements in daytime sleepiness (ESS) by 2.2 units (P = .001) and treatment self-efficacy by 0.2 units (P = .012) compared with the control group. CONCLUSIONS Subjects with OSA who received motivational enhancement education in addition to usual care were more likely to show better adherence to CPAP treatment, with greater improvements in treatment self-efficacy and daytime sleepiness. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT01173406; URL: www.clinicaltrials.gov.
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Affiliation(s)
- Agnes Y K Lai
- Department of Medicine, The University of Hong Kong, Hong Kong, SAR, China; Queen Mary Hospital, School of Nursing, The University of Hong Kong, Hong Kong, SAR, China
| | - Daniel Y T Fong
- Queen Mary Hospital, School of Nursing, The University of Hong Kong, Hong Kong, SAR, China
| | - Jamie C M Lam
- Department of Medicine, The University of Hong Kong, Hong Kong, SAR, China
| | - Terri E Weaver
- College of Nursing, University of Illinois at Chicago, Chicago, IL
| | - Mary S M Ip
- Department of Medicine, The University of Hong Kong, Hong Kong, SAR, China; Research Centre of Heart, Brain, Hormone, and Healthy Aging, The University of Hong Kong, Hong Kong, SAR, China.
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Mendelson M, Vivodtzev I, Tamisier R, Laplaud D, Dias-Domingos S, Baguet JP, Moreau L, Koltes C, Chavez L, De Lamberterie G, Herengt F, Levy P, Flore P, Pépin JL. CPAP treatment supported by telemedicine does not improve blood pressure in high cardiovascular risk OSA patients: a randomized, controlled trial. Sleep 2014; 37:1863-70. [PMID: 25364081 DOI: 10.5665/sleep.4186] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
STUDY OBJECTIVES Obstructive sleep apnea (OSA) has been associated with hypertension, which is one of the intermediary mechanisms leading to increased cardiovascular morbidity. This study aimed at evaluating the effects of a combination of continuous positive airway pressure (CPAP) and telemedicine support on blood pressure (BP) reduction in high cardiovascular risk OSA patients. DESIGN A multi-center randomized controlled trial that compared standard CPAP care and CPAP care and a telemedicine intervention. SETTING Sleep clinics in France. PATIENTS OR PARTICIPANTS 107 adult (18-65 years old) OSA patients (AHI > 15 events/h) with a high cardiovascular risk (cardiovascular SCORE > 5% or secondary prevention). INTERVENTIONS Patients were randomized to either standard care CPAP (n = 53) or CPAP and telemedicine (n = 54). Patients assigned to telemedicine were equipped with a smartphone for uploading BP measurements, CPAP adherence, sleepiness, and quality of life data; in return, they received pictograms containing health-related messages. MEASUREMENTS The main outcome was home self-measured BP and secondary outcomes were cardiovascular risk evolution, objective physical activity, CPAP adherence, sleepiness and quality of life. RESULTS Self-measured BP did not improve in either group (telemedicine or standard care). Patients in primary prevention showed greater BP reduction with CPAP treatment than those in secondary prevention. CONCLUSIONS CPAP treatment supported by telemedicine alone did not improve blood pressure and cardiovascular risk in high cardiovascular risk OSA patients. This study emphasizes the need for diet and physical activity training programs in addition to CPAP when aiming at decreasing cardiometabolic risk factors in these patients. CLINICAL TRIALS REGISTRATION ClinicalTrials.gov identifier: NCT01226641.
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Affiliation(s)
- Monique Mendelson
- Univ Grenoble Alpes, HP2 laboratory, Grenoble, France ; Inserm U1042, HP2, Grenoble, France ; CHU Grenoble, HP2, Grenoble, France
| | - Isabelle Vivodtzev
- Univ Grenoble Alpes, HP2 laboratory, Grenoble, France ; Inserm U1042, HP2, Grenoble, France ; CHU Grenoble, HP2, Grenoble, France
| | - Renaud Tamisier
- Univ Grenoble Alpes, HP2 laboratory, Grenoble, France ; Inserm U1042, HP2, Grenoble, France ; CHU Grenoble, HP2, Grenoble, France
| | | | - Sonia Dias-Domingos
- Univ Grenoble Alpes, HP2 laboratory, Grenoble, France ; Inserm U1042, HP2, Grenoble, France ; CHU Grenoble, HP2, Grenoble, France
| | | | | | | | | | | | | | - Patrick Levy
- Univ Grenoble Alpes, HP2 laboratory, Grenoble, France ; Inserm U1042, HP2, Grenoble, France ; CHU Grenoble, HP2, Grenoble, France
| | - Patrice Flore
- Univ Grenoble Alpes, HP2 laboratory, Grenoble, France ; Inserm U1042, HP2, Grenoble, France ; CHU Grenoble, HP2, Grenoble, France
| | - Jean-Louis Pépin
- Univ Grenoble Alpes, HP2 laboratory, Grenoble, France ; Inserm U1042, HP2, Grenoble, France ; CHU Grenoble, HP2, Grenoble, France
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Isetta V, León C, Torres M, Embid C, Roca J, Navajas D, Farré R, Montserrat JM. Telemedicine-based approach for obstructive sleep apnea management: building evidence. Interact J Med Res 2014; 3:e6. [PMID: 24554392 PMCID: PMC3961625 DOI: 10.2196/ijmr.3060] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 01/17/2014] [Accepted: 01/19/2014] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Telemedicine 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. OBJECTIVE The 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. METHODS We 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. RESULTS More 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. CONCLUSIONS OSA 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.
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Affiliation(s)
- Valentina Isetta
- Unit of Biophysics and Bioengineering, Faculty of Medicine, University of Barcelona, Barcelona, Spain.
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Chiner E, Andreu AL, Sancho-Chust JN, Sánchez-de-la-Torre A, Barbé F. The use of ambulatory strategies for the diagnosis and treatment of obstructive sleep apnea in adults. Expert Rev Respir Med 2014; 7:259-73. [DOI: 10.1586/ers.13.19] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Wozniak DR, Lasserson TJ, Smith I. Educational, supportive and behavioural interventions to improve usage of continuous positive airway pressure machines in adults with obstructive sleep apnoea. Cochrane Database Syst Rev 2014:CD007736. [PMID: 24399660 DOI: 10.1002/14651858.cd007736.pub2] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Although effective in the treatment of obstructive sleep apnoea (OSA), continuous positive airway pressure (CPAP) is not universally accepted by users. Educational, supportive and behavioural interventions may help people with OSA recognise the need for regular and continued use of CPAP. OBJECTIVES To assess the effectiveness of strategies that are educational, supportive or behavioural in encouraging people who have been prescribed CPAP to use their machines. SEARCH METHODS Searches were conducted on the Cochrane Airways Group Specialised Register of trials. Searches are current to 17 January 2013. SELECTION CRITERIA We included randomised parallel controlled trials that assessed an intervention designed to inform participants about CPAP or OSA, to support them in using CPAP or to modify their behaviour in increasing their use of CPAP machines. Studies of any duration were considered. DATA COLLECTION AND ANALYSIS Two review authors assessed studies to determine their suitability for inclusion in the review. Data were extracted independently and were entered into Review Manager software for analysis. MAIN RESULTS Thirty studies (2047 participants) were included. We categorised studies by intervention type: supportive interventions during follow-up, educational interventions and behavioural therapy. Across all three intervention classes, most studies incorporated elements of more than one intervention. For the purposes of this systematic review, we categorised them by the prevailing type of intervention, which we expected would have the greatest impact on the study outcome.Baseline Epworth Sleepiness Scale (ESS) scores indicated that most participants experienced daytime sleepiness, and CPAP was indicated on the basis of sleep disturbance indices. A vast majority of recruited participants had not used CPAP previously. Most of the studies were at an unclear risk of bias overall, although because of the nature of the intervention, blinding of both study personnel and participants was not feasible, and this affected a number of key outcomes. Adverse events were not reported in these studies.Low- to moderate-quality evidence showed that all three types of interventions led to increased machine usage in CPAP-naive participants with moderate to severe OSA syndrome. Compared with usual care, supportive ongoing interventions increased machine usage by about 50 minutes per night (0.82 hours, 95% confidence interval (CI) 0.36 to 1.27, N = 803, 13 studies; low-quality evidence), increased the number of participants who used their machines for longer than four hours per night from 59 to 75 per 100 (odds ratio (OR) 2.06, 95% CI 1.22 to 3.47, N = 268, four studies; low-quality evidence) and reduced the likelihood of study withdrawal (OR 0.65, 95% CI 0.44 to 0.97, N = 903, 12 studies; moderate-quality evidence). With the exception of study withdrawal, considerable variation was evident between the results of individual studies across these outcomes. Evidence of an effect on symptoms and quality of life was statistically imprecise (ESS score -0.60 points, 95% CI -1.81 to 0.62, N = 501, eight studies; very low-quality evidence; Functional Outcomes of Sleep Questionnaire 0.98 units, 95% CI -0.84 to 2.79, N = 70, two studies; low-quality evidence, respectively).Educational interventions increased machine usage by about 35 minutes per night (0.60 hours, 95% CI 0.27 to 0.93, N = 508, seven studies; moderate-quality evidence), increased the number of participants who used their machines for longer than four hours per night from 57 to 70 per 100 (OR 1.80, 95% CI 1.09 to 2.95, N = 285, three studies; low-quality evidence) and reduced the likelihood of withdrawal from the study (OR 0.67, 95% CI 0.45 to 0.98, N = 683, eight studies; low-quality evidence). Participants experienced a small improvement in symptoms, the size of which may not be clinically significant (ESS score -1.17 points, 95% CI -2.07 to -0.26, N = 336, five studies).Behavioural therapy led to substantial improvement in average machine usage of 1.44 hours per night (95% CI 0.43 to 2.45, N = 584, six studies; low-quality evidence) and increased the number of participants who used their machines for longer than four hours per night from 28 to 47 per 100 (OR 2.23, 95% CI 1.45 to 3.45, N = 358, three studies; low-quality evidence) but with high levels of statistical heterogeneity. The estimated lower rate of withdrawal with behavioural interventions was imprecise and did not reach statistical significance (OR 0.85, 95% CI 0.57 to 1.25, N = 609, five studies, very low-quality evidence). AUTHORS' CONCLUSIONS In CPAP-naive people with severe sleep apnoea, low-quality evidence indicates that supportive interventions that encourage people to continue to use their CPAP machines increase usage compared with usual care. Moderate-quality evidence shows that a short-term educational intervention results in a modest increase in CPAP usage. Low-quality evidence indicates that behavioural therapy leads to a large increase in CPAP machine usage. The impact of improved CPAP usage on daytime sleepiness, quality of life and long-term cardiovascular risks remains unclear. For outcomes reflecting machine usage, we downgraded for risk of bias and inconsistency. An additional limitation for daytime sleepiness and quality of life measures was imprecision. Trials in people who have struggled to persist with treatment are needed, as currently little evidence is available for this population. Optimal timing and duration and long-term effectiveness of interventions remain uncertain. The relationship between improved machine usage and effect on symptoms and quality of life requires further assessment. Studies addressing the choice of interventions that best match individual patient needs and therefore result in the most successful and cost-effective therapy are needed.
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Affiliation(s)
- Dariusz R Wozniak
- Respiratory Support and Sleep Centre, Papworth Hospital, Papworth Everard, Cambridge, UK, CB23 3RE
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Schwab RJ, Badr SM, Epstein LJ, Gay PC, Gozal D, Kohler M, Lévy P, Malhotra A, Phillips BA, Rosen IM, Strohl KP, Strollo PJ, Weaver EM, Weaver TE. An official American Thoracic Society statement: continuous positive airway pressure adherence tracking systems. The optimal monitoring strategies and outcome measures in adults. Am J Respir Crit Care Med 2013; 188:613-20. [PMID: 23992588 DOI: 10.1164/rccm.201307-1282st] [Citation(s) in RCA: 174] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Continuous positive airway pressure (CPAP) is considered the treatment of choice for obstructive sleep apnea (OSA), and studies have shown that there is a correlation between patient adherence and treatment outcomes. Newer CPAP machines can track adherence, hours of use, mask leak, and residual apnea-hypopnea index (AHI). Such data provide a strong platform to examine OSA outcomes in a chronic disease management model. However, there are no standards for capturing CPAP adherence data, scoring flow signals, or measuring mask leak, or for how clinicians should use these data. METHODS American Thoracic Society (ATS) committee members were invited, based on their expertise in OSA and CPAP monitoring. Their conclusions were based on both empirical evidence identified by a comprehensive literature review and clinical experience. RESULTS CPAP usage can be reliably determined from CPAP tracking systems, but the residual events (apnea/hypopnea) and leak data are not as easy to interpret as CPAP usage and the definitions of these parameters differ among CPAP manufacturers. Nonetheless, ends of the spectrum (very high or low values for residual events or mask leak) appear to be clinically meaningful. CONCLUSIONS Providers need to understand how to interpret CPAP adherence tracking data. CPAP tracking systems are able to reliably track CPAP adherence. Nomenclature on the CPAP adherence tracking reports needs to be standardized between manufacturers and AHIFlow should be used to describe residual events. Studies should be performed examining the usefulness of the CPAP tracking systems and how these systems affect OSA outcomes.
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Wickwire EM, Lettieri CJ, Cairns AA, Collop NA. Maximizing Positive Airway Pressure Adherence in Adults. Chest 2013; 144:680-693. [DOI: 10.1378/chest.12-2681] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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Using Information and Communication Technology in Home Care for Communication between Patients, Family Members, and Healthcare Professionals: A Systematic Review. Int J Telemed Appl 2013; 2013:461829. [PMID: 23690763 PMCID: PMC3649237 DOI: 10.1155/2013/461829] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Revised: 01/17/2013] [Accepted: 02/03/2013] [Indexed: 12/02/2022] Open
Abstract
Introduction. Information and communication technology (ICT) are becoming a natural part in healthcare both for delivering and giving accessibility to healthcare for people with chronic illness living at home. Aim. The aim was to review existing studies describing the use of ICT in home care for communication between patients, family members, and healthcare professionals. Methods. A review of studies was conducted that identified 1,276 studies. A selection process and quality appraisal were conducted, which finally resulted in 107 studies. Results. The general results offer an overview of characteristics of studies describing the use of ICT applications in home care and are summarized in areas including study approach, quality appraisal, publications data, terminology used for defining the technology, and disease diagnosis. The specific results describe how communication with ICT was performed in home care and the benefits and drawbacks with the use of ICT. Results were predominated by positive responses in the use of ICT. Conclusion. The use of ICT applications in home care is an expanding research area, with a variety of ICT tools used that could increase accessibility to home care. Using ICT can lead to people living with chronic illnesses gaining control of their illness that promotes self-care.
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Balachandran JS, Yu X, Wroblewski K, Mokhlesi B. A brief survey of patients' first impression after CPAP titration predicts future CPAP adherence: a pilot study. J Clin Sleep Med 2013; 9:199-205. [PMID: 23493772 DOI: 10.5664/jcsm.2476] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND CPAP adherence patterns are often established very early in the course of therapy. Our objective was to quantify patients' perception of CPAP therapy using a 6-item questionnaire administered in the morning following CPAP titration. We hypothesized that questionnaire responses would independently predict CPAP adherence during the first 30 days of therapy. METHODS We retrospectively reviewed the CPAP perception questionnaires of 403 CPAP-naïve adults who underwent in-laboratory titration and who had daily CPAP adherence data available for the first 30 days of therapy. Responses to the CPAP perception questionnaire were analyzed for their association with mean CPAP adherence and with changes in daily CPAP adherence over 30 days. RESULTS Patients were aged 52 ± 14 years, 53% were women, 54% were African American, the mean body mass index (BMI) was 36.3 ± 9.1 kg/m(2), and most patients had moderate-severe OSA. Four of 6 items from the CPAP perception questionnaire- regarding difficulty tolerating CPAP, discomfort with CPAP pressure, likelihood of wearing CPAP, and perceived health benefit-were significantly correlated with mean 30-day CPAP adherence, and a composite score from these 4 questions was found to be internally consistent. Stepwise linear regression modeling demonstrated that 3 variables were significant and independent predictors of reduced mean CPAP adherence: worse score on the 4-item questionnaire, African American race, and non-sleep specialist ordering polysomnogram and CPAP therapy. Furthermore, a worse score on the 4-item CPAP perception questionnaire was consistently associated with decreased mean daily CPAP adherence over the first 30 days of therapy. CONCLUSIONS In this pilot study, responses to a 4-item CPAP perception questionnaire administered to patients immediately following CPAP titration independently predicted mean CPAP adherence during the first 30 days. Further prospective validation of this questionnaire in different patient populations is warranted.
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Affiliation(s)
- Jay S Balachandran
- Sleep Disorders Center, Section of Pulmonary and Critical Care, Department of Medicine, Chicago, IL, USA
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Coma-Del-Corral MJ, Alonso-Álvarez ML, Allende M, Cordero J, Ordax E, Masa F, Terán-Santos J. Reliability of telemedicine in the diagnosis and treatment of sleep apnea syndrome. Telemed J E Health 2012. [PMID: 23186084 DOI: 10.1089/tmj.2012.0007] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Advances in information technology and telecommunications have provided the option of making it easier to diagnose and treat obstructive sleep apnea syndrome (OSAS) using telemedicine techniques. This study assessed the feasibility and reliability of respiratory polygraphy and prescription of treatment by pressure adjustment with auto-continuous positive airway pressure (CPAP) systems, both being transmitted telematically to the Sleep Unit, with teleconsultation as a support method. SUBJECTS AND METHODS Forty patients were studied from a population 80 km from the Sleep Unit using respiratory polygraphy transmitted in real time. They were divided into two groups: one was seen by conventional consultation, and the other was seen using teleconsultation. We also estimated satisfaction with this system and its costs. RESULTS The mean patient age was 53 ± 10.3 years, with a body mass index of 31 ± 6.2 kg/m(2) and an Epworth score of 12 ± 5.3. In total, 35 patients were diagnosed with OSAS, with an Apnea-Hypopnea Index of ≥10, and CPAP treatment was started in 16 of them. The agreement in the Apnea-Hypopnea Index, total apneas and hypopneas, mean oxygen saturation, and time with an oxygen saturation <90% was greater than 90% between the studies transmitted in real time and those stored in the polygraph. The level of compliance with CPAP treatment was 85% for the patients who were seen in a conventional clinic and 75% in those seen by teleconsultation. CONCLUSIONS The use of telematic techniques is useful to establish a diagnostic and therapeutic strategy for OSAS with the creation of a Wide Core Sleep Laboratory as a process controller.
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Effectiveness of a group education session on adherence with APAP in obstructive sleep apnea—a randomized controlled study. Sleep Breath 2012. [DOI: 10.1007/s11325-012-0789-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Rojjanasrirat W, Nelson EL, Wambach KA. A pilot study of home-based videoconferencing for breastfeeding support. J Hum Lact 2012; 28:464-7. [PMID: 22802355 DOI: 10.1177/0890334412449071] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Research on using videoconferencing for breastfeeding support is limited. PURPOSE Although European case reports have described videoconferencing for providing lactation support, this was the first study to assess the reliability and feasibility of home videoconferencing for breastfeeding assessment and support in the United States. METHOD The study used 4 real-time, secure videoconferencing sessions to deliver lactation support to 10 mothers in the home. To assess interrater reliability, percentage agreement was calculated on LATCH assessment scores from telehealth and home-visit International Board Certified Lactation Consultants (IBCLCs) during the first 2 visits. Participants' perceptions of satisfaction and the overall experiences were documented. RESULTS The percentage agreement on the 5 LATCH score dimensions ranged between 40% to 100% during the first visit and 80% to 100% during the second visit. To assess feasibility, participants reported their satisfaction with the technology and their perceptions of the videoconference consultation. All participants "strongly agreed" that they were comfortable talking about breastfeeding concerns using home videoconferencing. CONCLUSION The findings suggest videoconferencing can potentially be used to support breastfeeding mothers in their homes.
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Bhunia GS, Kesari S, Chatterjee N, Kumar V, Das P. Telehealth: a perspective approach for visceral leishmaniasis (kala-azar) control in India. Pathog Glob Health 2012; 106:150-8. [PMID: 23265372 PMCID: PMC4001574 DOI: 10.1179/2047773212y.0000000014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Visceral leishmaniasis, also known as kala-azar, is a vector borne disease caused by the protozoan parasite, L. donovani. Poor and neglected populations in Indian sub-continent are particularly affected by this disease. Due to the diversity of epidemiological situations, no single diagnosis, treatment, or control will be suitable for all. Control measures through case findings, treatment, and vector control are seldom used, even where they could be useful. Modern tools like telehealth, using space technology, have now come in handy to address issues of disease surveillance, control checking, and evaluation. The present study focuses on telehealth as a current vector control strategy, perspectives on diagnosis, treatment, and control of visceral leishmaniasis as these deserve more attention and research.
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Affiliation(s)
- Gouri Sankar Bhunia
- Department of Vector Biology and Control, Rajendra Memorial Research Institute of Medical Sciences (ICMR), Patna, Bihar, India
| | - Shreekant Kesari
- Department of Vector Biology and Control, Rajendra Memorial Research Institute of Medical Sciences (ICMR), Patna, Bihar, India
| | - Nandini Chatterjee
- Department of Geography, Presidency University, Kolkata, West Bengal, India
| | - Vijay Kumar
- Department of Vector Biology and Control, Rajendra Memorial Research Institute of Medical Sciences (ICMR), Patna, Bihar, India
| | - Pradeep Das
- Department of Vector Biology and Control, Rajendra Memorial Research Institute of Medical Sciences (ICMR), Patna, Bihar, India
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Fox N, Hirsch-Allen AJ, Goodfellow E, Wenner J, Fleetham J, Ryan CF, Kwiatkowska M, Ayas NT. The impact of a telemedicine monitoring system on positive airway pressure adherence in patients with obstructive sleep apnea: a randomized controlled trial. Sleep 2012; 35:477-81. [PMID: 22467985 DOI: 10.5665/sleep.1728] [Citation(s) in RCA: 134] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
STUDY OBJECTIVES First-line therapy for patients with moderate to severe obstructive sleep apnea (OSA) is positive airway pressure (PAP). Although PAP is a highly efficacious treatment, adherence to PAP is still a substantial clinical problem. The objective of this study was to determine whether PAP adherence can be improved with a telemedicine monitoring system. DESIGN A nonblinded, single-center, randomized controlled trial that compared standard PAP treatment versus PAP treatment and a telemedicine monitoring system SETTING University sleep disorders program in British Columbia, Canada PATIENTS Adult patients (≥ 19 yr of age) with moderate to severe OSA (apnea hypopnea index (AHI) ≥ 15 events/hr determined by polysomnography) prescribed PAP INTERVENTIONS: Patients were randomized to either standard care with an autotitrating PAP machine or an autotitrating PAP machine that transmitted physiologic information (i.e., adherence, air leak, residual AHI) daily to a website that could be reviewed. If problems were identified from information from the website, the patient was contacted by telephone as necessary. MEASUREMENTS PAP adherence after 3 mo, subjective sleep quality, and side effects RESULTS Seventy-five patients were enrolled; 39 were randomized to telemedicine and 36 to standard care. The mean age ± standard deviation (SD) was 53.5 ± 11.2 yr, mean AHI was 41.6 ± 22.1 events/hr, and 80% of patients were male. After 3 mo, mean PAP adherence was significantly greater in the telemedicine arm (191 min per day) versus the standard arm (105 min per day; mean difference = 87 min, 95% confidence interval (CI): 25-148 min, P = 0.006, unpaired t test). On days when PAP was used, mean adherence was 321 min in the telemedicine arm and 207 min in the standard arm (difference = 113 min, 95% CI: 62-164 min, P < 0.0001). Significant independent predictors of adherence included age, baseline Epworth Sleepiness Scale score, and use of telemedicine. On average, an additional 67 min of technician time was spent on patients in the telemedicine arm compared with the standard arm (P = 0.0001). CONCLUSIONS PAP adherence can be improved with the use of a web-based telemedicine system at the initiation of treatment.
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Affiliation(s)
- Nurit Fox
- Sleep Disorders Program, University of British Columbia Hospital, Vancouver, British Columbia, Canada
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Meurice JC. Comment améliorer l’observance vis-à-vis de la PPC dans le syndrome d’apnées du sommeil : du « coaching » à la télémédecine. Rev Mal Respir 2012; 29:7-10. [DOI: 10.1016/j.rmr.2011.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Accepted: 12/09/2011] [Indexed: 11/16/2022]
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Parikh R, Touvelle MN, Wang H, Zallek SN. Sleep telemedicine: patient satisfaction and treatment adherence. Telemed J E Health 2011; 17:609-14. [PMID: 21859348 DOI: 10.1089/tmj.2011.0025] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Obstructive sleep apnea is common, but access to diagnosis remains limited. Telemedicine may allow greater access to care; however, its effect on patient satisfaction and treatment adherence is unknown. This study compares patient satisfaction and continuous positive airway pressure (CPAP) adherence of patients seen by videoconference with those seen in person. MATERIALS AND METHODS New patients seen via video or in person at a sleep center completed a survey, with three questions pertaining to satisfaction with the provider. Questions were scored 1-5; the sum was the patient satisfaction score. CPAP adherence was retrospectively analyzed in patients who met the physician via video or in person. Percentage of nights CPAP was used for ≥4 h and average minutes of CPAP use per night over 2 consecutive weeks were compared. RESULTS A Mann-Whitney test compared patient satisfaction of the 90 subjects (of whom, 56 met physician in person and 34 via video). Mean scores (in person, 14.82; video, 14.91; p=0.851) did not differ between groups. Mann-Whitney tests compared CPAP adherence in the 172 subjects (of whom, 111 met physician in person and 61 via video). Mean percentage of nights CPAP was used ≥4 h (in person, 71%; video, 65%; p=0.198) and the average minutes per night of CPAP use (in person, 340.55; video, 305.31; p=0.153) did not differ between groups. CONCLUSIONS The findings indicate that patients were equally satisfied with their provider and adherent to CPAP treatment whether they were seen in person or via video. Videoconferencing may improve access to patient care without reducing patient satisfaction or treatment adherence.
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Affiliation(s)
- Roshni Parikh
- University of Illinois College of Medicine, Peoria, Illinois 61602, USA.
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Sawyer AM, Gooneratne NS, Marcus CL, Ofer D, Richards KC, Weaver TE. A systematic review of CPAP adherence across age groups: clinical and empiric insights for developing CPAP adherence interventions. Sleep Med Rev 2011; 15:343-56. [PMID: 21652236 DOI: 10.1016/j.smrv.2011.01.003] [Citation(s) in RCA: 582] [Impact Index Per Article: 44.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Revised: 01/17/2011] [Accepted: 01/18/2011] [Indexed: 12/11/2022]
Abstract
Continuous positive airway pressure (CPAP) is a highly efficacious treatment for obstructive sleep apnea (OSA) but adherence to the treatment limits its overall effectiveness across all age groups of patients. Factors that influence adherence to CPAP include disease and patient characteristics, treatment titration procedures, technological device factors and side effects, and psychological and social factors. These influential factors have guided the development of interventions to promote CPAP adherence. Various intervention strategies have been described and include educational, technological, psychosocial, pharmacological, and multi-dimensional approaches. Though evidence to date has led to innovative strategies that address adherence in CPAP-treated children, adults, and older adults, significant opportunities exist to develop and test interventions that are clinically applicable, specific to sub-groups of patients likely to demonstrate poor adherence, and address the multi-factorial nature of CPAP adherence. The translation of CPAP adherence promotion interventions to clinical practice is imperative to improve health and functional outcomes in all persons with CPAP-treated OSA.
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Affiliation(s)
- Amy M Sawyer
- University of Pennsylvania School of Nursing, Biobehavioral Health Sciences Division, USA.
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