Remote Ambulatory Management of Veterans with Obstructive Sleep Apnea

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.

Keywords: auto-titrating positive airway pressure; home sleep testing; obstructive sleep apnea; telemedicine.

Figure 1

Cohort diagram of participants randomized to in-person versus telemedicine-based pathways. APAP, automatically-adjusting positive airway pressure; FU, follow-up; HST, home sleep testing; INP, in-person; OSA, obstructive sleep apnea; TELE, telemedicine.

Figure 2

Box plots illustrating 3-mo adjusted mean changes in FOSQ score by study arm per protocol. Horizontal line within boxes is the median change. Upper and lower box boundaries are 75^th and 25^th percentile respectively. Whiskers represent distance to minimum and maximum values. FOSQ, Functional Outcomes of Sleep Questionnaire.