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Telemonitoring of CPAP therapy may save nursing time

  • Sleep Breathing Physiology and Disorders • Original Article
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Abstract

Purpose

Telemonitoring might enhance continuous positive airway pressure (CPAP) adherence and save nursing time at the commencement of CPAP therapy. We tested wireless telemonitoring (ResTraxx Online System®, ResMed) during the habituation phase of the CPAP therapy in obstructive sleep apnea syndrome (OSAS).

Methods

In total, 111 consecutive OSAS patients were enrolled. After CPAP titration, patients were followed with the telemonitoring (TM, N = 50) or the usual care (UC, N = 61). The TM group used fixed pressure CPAP device with and the UC group similar device without wireless telemonitoring. Patients and study nurses were unblinded. The evaluated end-points were hours of CPAP use >4 h/day, mask leak <0.4 L/s, and AHI <5/h. Nursing time including extra phone calls, visits, and telemonitoring time was recorded during the habituation phase. CPAP adherence was controlled in the beginning and at the end of the habituation phase and after 1-year of use.

Results

TM and UC groups did not differ in terms of patient characteristics. The average length of the habituation phase was 4 weeks in the TM group and fixed 3 months in the UC group. Median nursing time was 39 min (range 12–132 min) in the TM group and shorter compared to that of 58 min (range 40–180 min) (p < 0.001) per patient in the UC group. Both treatment groups had high CPAP usage hours (>4 h/day) and the change in usage at the end of the habituation phase did not differ between the groups (p = 0.39). Patients in both groups were equally satisfied with the treatment protocol. CPAP adherence (6.4 h in TM vs. 6.1 h in UC group, p = 0.63) and residual AHI (1.3 in TM vs. 3.2 in UC group, p = 0.04) were good in both groups at 1-year follow-up.

Conclusions

Wireless telemonitoring of CPAP treatment could be relevant in closing the gap between the increasing demand and available health-care resources. It may save nursing time without compromising short- or long-term effectiveness of CPAP treatment in OSAS.

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References

  1. Young T, Peppard PE, Gottlieb DJ (2002) Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med 165:1217–1239

    Article  PubMed  Google Scholar 

  2. Shahar E, Whitney CW, Redline S, Lee ET, Newman AB, Nieto FJ, O’Connor GT, Boland LL, Schwartz JE, Samet JM (2001) Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med 163:19–25

    Article  CAS  PubMed  Google Scholar 

  3. Tregear S, Reston J, Schoelles K, Phillips B (2009) Obstructive sleep apnea and risk of motor vehicle crash: systematic review and meta-analysis. J Clin Sleep Med 5:573–581

    PubMed  PubMed Central  Google Scholar 

  4. Gay P, Weaver T, Loube D, Iber C, Positive Airway Pressure Task Force, Standards of Practice Committee, American Academy of Sleep Medicine (2006) Evaluation of positive airway pressure treatment for sleep related breathing disorders in adults. Sleep 29:381–401

    Article  PubMed  Google Scholar 

  5. Sawyer AM, Gooneratne NS, Marcus CL, Ofer D, Richards KC, Weaver TE (2011) A systematic review of CPAP adherence across age groups: clinical and empiric insights for developing CPAP adherence interventions. Sleep Med Rev 15:343–356

    Article  PubMed  PubMed Central  Google Scholar 

  6. Schwab RJ, Badr SM, Epstein LJ, et al. (2013) 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 188:613–620

    Article  Google Scholar 

  7. Crawford MR, Espie CA, Bartlett DJ, Grunstein RR (2014) Integrating psychology and medicine in CPAP adherence—new concepts? Sleep Med Rev 18:123–139

    Article  PubMed  Google Scholar 

  8. Shapiro GK, Shapiro CM (2010) Factors that influence CPAP adherence: an overview. Sleep Breath 14:323–335

    Article  PubMed  Google Scholar 

  9. Weaver TE, Grunstein RR (2008) Adherence to continuous positive airway pressure therapy: the challenge to effective treatment. Proc Am Thorac Soc 5:173–178

    Article  PubMed  PubMed Central  Google Scholar 

  10. Engleman HM, Wild MR (2003) Improving CPAP use by patients with the sleep apnoea/hypopnoea syndrome (SAHS). Sleep Med Rev 7:81–89

    Article  PubMed  Google Scholar 

  11. Weaver TE, Maislin G, Dinges DF, Bloxham T, George CF, Greenberg H, Kader G, Mahowald M, Younger J, Pack AI (2007) Relationship between hours of CPAP use and achieving normal levels of sleepiness and daily functioning. Sleep 30:711–719

    Article  PubMed  PubMed Central  Google Scholar 

  12. Weaver TE, Sawyer AM (2010) Adherence to continuous positive airway pressure treatment for obstructive sleep apnoea: implications for future interventions. Ind J Med Res 131:245–258

    Google Scholar 

  13. Weaver TE (2013) Don’t start celebrating—CPAP adherence remains a problem. J Clin Sleep Med 9:551–552

    PubMed  PubMed Central  Google Scholar 

  14. Fox N, Hirsch-Allen AJ, Goodfellow E, Wenner J, Fleetham J, Ryan CF, Kwiatkowska M, Ayas NT (2012) The impact of a telemedicine monitoring system on positive airway pressure adherence in patients with obstructive sleep apnea: a randomized controlled trial. Sleep 35:477–481

    Article  PubMed  PubMed Central  Google Scholar 

  15. Wilson SR, Cram P (2012) Another sobering result for home telehealth—and where we might go next. Arch Intern Med 172:779–780

    PubMed  Google Scholar 

  16. Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth Sleepiness Scale. Sleep 14:540–545

    Article  CAS  PubMed  Google Scholar 

  17. Goldberg DP, Gater R, Sartorius N, Ustun TB, Piccinelli M, Gureje O, Rutter C (1997) The validity of two versions of the GHQ in the WHO study of mental illness in general health care. Psychol Med 27:191–197

    Article  CAS  PubMed  Google Scholar 

  18. Salokangas RK, Poutanen O, Stengård E (1995) Screening for depression in primary care. Development and validation of the Depression Scale, a screening instrument for depression. Acta Psychiatr Scand 92:10–16

    Article  CAS  PubMed  Google Scholar 

  19. Isetta V, Ruiz M, Farré R, Montserrat JM (2015) Supporting patients receiving CPAP treatment: the role of training and telemedicine. ERS Monogr 67:280–292

    Google Scholar 

  20. Taylor Y, Eliasson A, Andrada T, Kristo D, Howard R (2006) The role of telemedicine in CPAP compliance for patients with obstructive sleep apnea syndrome. Sleep Breath 10:132–138

    Article  PubMed  Google Scholar 

  21. Smith CE, Dauz ER, Clements F, Puno FN, Cook D, Doolittle G, Leeds W (2006) Telehealth services to improve nonadherence: a placebo-controlled study. Telemed J E Health 12:289–296

    Article  PubMed  Google Scholar 

  22. Sparrow D, Aloia M, Demolles DA, Gottlieb DJ (2010) A telemedicine intervention to improve adherence to continuous positive airway pressure: a randomised controlled trial. Thorax 65:1061–1066

    Article  PubMed  Google Scholar 

  23. Stepnowsky CJ, Palau JJ, Marler MR, Gifford AL (2007) Pilot randomized trial of the effect of wireless telemonitoring on compliance and treatment efficacy in obstructive sleep apnea. J Med Internet Res 9:e14

    PubMed  PubMed Central  Google Scholar 

  24. Chai-Coetzer CL, Luo YM, Antic NA, Zhang XL, Chen BY, He QY, Heeley E, Huang SG, Anderson C, Zhong NS, McEvoy RD (2013) Predictors of long-term adherence to continuous positive airway pressure therapy in patients with obstructive sleep apnea and cardiovascular disease in the SAVE study. Sleep 36:1929–1937

    Article  PubMed  PubMed Central  Google Scholar 

  25. Engleman HM, Martin SE, Douglas NJ (1994) Compliance with CPAP therapy in patients with the sleepapnoea/hypopnoea syndrome. Thorax 49:263–266

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Kushida CA, Littner MR, Hirshkowitz M, et al. (2006) Practice parameters for the use of continuous and bilevel positive airway pressure devices to treat adult patients with sleep-related breathing disorders. Sleep 29:375–380

    Article  PubMed  Google Scholar 

  27. Aloia MS, Arnedt JT, Stanchina M, Millman RP (2007) How early in treatment is PAP adherence established? Revisiting night-to-night variability. Behav Sleep Med 5:229–240

    Article  PubMed  Google Scholar 

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Acknowledgments

ResTraxx Online System® was provided by ResMed Finland.

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Correspondence to Ulla Anttalainen.

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Conflict of interest

Ulla Anttalainen and Tarja Laitinen declared no financial support or conflicts of interest. Tarja Saaresranta declared speaking fee from ResMed Finland. Sari Melkko and Sirkka Hakko declared congress travel fee from ResMed Finland.

Ethical standards

The study was approved by the Division of Medicine of the Turku University Hospital. The Ethics Committee approval was not required, since this study was part of our quality assurance procedure to revise the treatment protocol. Patients allocated for the TM group gave their written informed consent for the management of their data through telemonitoring. The study is registered in the ClinicalTrials.gov (ClinicalTrials.gov identifier: NCT02509247).

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Anttalainen, U., Melkko, S., Hakko, S. et al. Telemonitoring of CPAP therapy may save nursing time. Sleep Breath 20, 1209–1215 (2016). https://doi.org/10.1007/s11325-016-1337-9

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  • DOI: https://doi.org/10.1007/s11325-016-1337-9

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