The emerging role of telemedicine in diagnosing and treating sleep disorders

Feasibility and acceptability of a virtual diagnostic sleep disorders service: A qualitative study

INTRODUCTION

The electronic collection of patient data is used for a large variety of conditions. The boundaries of its use in initial diagnostics and the extent to which it can replace specialist contact, however, remain vague. Our newly developed virtual diagnostic process for common sleep disorders involves digital questionnaire administration, neurophysiological diagnostic studies, and virtual consultation with a sleep specialist. In this study, we evaluated patients' virtual diagnostic process experiences as part of a full evaluation of this process.

METHODS

Patients who completed the virtual diagnostic process participated in online semi-structured interviews based on the following criteria: age ≥ 18 years, no obvious cognitive deficits, and access to the internet. Patients who did not complete the virtual diagnostic process were contacted by telephone and given the opportunity to explain why.

RESULTS

Of the 24 patients included, 14 completed the virtual diagnostic process. Most participants understood the concept of the virtual diagnostic process, could navigate the process, and felt that the combined use of a questionnaire and virtual consultation was meaningful. Although participants could provide information as free text, the simplified closed questions, required for diagnostic classification, triggered feelings of insecurity and the inability to sufficiently describe symptoms, thereby evoking concern. All patients deemed the complementary personal contact important.

DISCUSSION

The findings demonstrate that the virtual diagnostic process is feasible and highly accepted by most patients. However, (virtual) personal (telephone or video) contact is mandatory to address patients' concerns. The virtual diagnostic process application evaluated here likely represents the outer limit of the use of electronic data collection in virtual diagnostic procedures.

The concomitant relationship shared by sleep disturbances and type 2 diabetes: developing telemedicine as a viable treatment option

Individually, sleep disturbances and type 2 diabetes pose pervasive challenges to health. In addition, the negative symptomology associated with each condition is exacerbated further when presenting concomitantly. This relationship formulates a destructive loop wherein those with diabetes experience decreased sleep quality, which, in turn, worsens a wide range of health threats experienced by those with diabetes, including obesity and glucose intolerance. Because major lifestyle changes and daily care are needed to effectively manage both diabetes and sleep disturbances, an efficient and timely modality of treatment is essential. Advanced technology incorporating telemedicine and telehealth has the potential to enhance treatment by delivering accepted standard of care, medical monitoring, and education quickly and seamlessly--even in rural locations. This type of intervention has the added potential benefit of fostering patient empowerment.

Experience with telehealth for sleep monitoring and sleep laboratory management

In 2009, we established a pilot telehealth service to a sleep laboratory in Garden City, Kansas, approximately 600 km from the Kansas University Medical Center. Videoconferencing was used for polysomnography (PSG) study follow-up, patient monitoring and sleep laboratory medical management. It allowed the sleep specialist to treat patients and collaborate with sleep laboratory personnel from a distance without extensive travel. In the first six months the telemedicine clinic was held on six occasions. There were 18 new patient evaluations and four follow up visits. The most common diagnosis was obstructive sleep apnoea. The videoconferencing equipment and the intraoral camera worked well. Interviewing and examining patients via telemedicine was very similar to doing it in-person. Telemedicine was effective for the physician-patient interaction and for visualizing airway structures. Although more research is needed, the use of videoconferencing for sleep study follow-up and laboratory oversight appears very promising.

Delivery of pediatric sleep services via telehealth: the Alberta experience and lessons learned

Concerns regarding a child's sleep, identified by a caregiver or by the health care practitioner, are commonly raised but often left unexplored. Families in geographically isolated areas, with limited access to specialty services such as pediatric sleep medicine, are at increased risk for unmet treatment needs. Telehealth is a potential vehicle for delivery of these specialty services and overcoming barriers in diagnosing and treating sleep disorders in children by improving access and enhancing support for the families in their communities. This article describes the initiation of a pilot program in the delivery of multidisciplinary pediatric sleep medicine services via telehealth in Alberta, Canada.