Telemedicine-based approach for obstructive sleep apnea management: building evidence

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.

Keywords: CPAP therapy; sleep apnea; teleconsultation; telemedicine.

Figure 1

Frequency distribution of the answers to question A (satisfaction with the teleconsultation), B (percentage of face-to-face that could be replaced by teleconsultation), and C (inclination to recommend teleconsultation to others) of the opinion questionnaire stratified by age, gender, Internet use, and education (graduate studies or not) of the patients included in the first study. Significant differences between distributions (P<.05) are shown in italics.

Figure 2

Results of the first part of patients’ evaluation regarding what they learned about OSA and CPAP therapy during the training session (study 2). The box-and-whickers plot shows the percentage of correct answers to the multiple choice test performed by the two randomized groups.

Figure 3

Results distribution of the practical evaluation of patients’ skills on placing the mask, the headgear, and avoiding leaks from the mask (study 2). A blinded expert scored patients’ performance on a ascendant scale: 0 (bad), 1 (average), and 2 (good).