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Ramezani A, Sharafkhaneh A, BaHammam AS, Kuna ST, Razjouyan J. Effects of COVID-19 on Sleep Services Use and Its Recovery. Nat Sci Sleep 2024; 16:761-768. [PMID: 38882925 PMCID: PMC11179655 DOI: 10.2147/nss.s456214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 06/05/2024] [Indexed: 06/18/2024] Open
Abstract
Purpose The COVID-19 pandemic affected the utilization of various healthcare services differentially. Sleep testing services utilization (STU), including Home Sleep Apnea Testing (HSAT) and Polysomnography (PSG), were uniquely affected. We assessed the effects of the pandemic on STU and its recovery using the Veterans Health Administration (VHA) data. Patients and Methods A retrospective cohort study from the VHA between 01/2019 and 10/2023 of veterans with age ≥ 50. We extracted STU data using Current Procedural Terminology codes for five periods based on STU and vaccination status: pre-pandemic (Pre-Pan), pandemic sleep test moratorium (Pan-Mor), and pandemic pre-vaccination (Pan-Pre-Vax), vaccination (Pan-Vax), and postvaccination (Pan-Post-Vax). We compared STU between intervals (Pre-Pan as the reference). Results Among 261,371 veterans (63.7±9.6 years, BMI 31.9±6.0 kg/m², 80% male), PSG utilization decreased significantly during Pan-Mor (-56%), Pan-Pre-Vax (-61%), Pan-Vax (-42%), and Pan-Post-Vax (-36%) periods all compared to Pre-Pan. HSAT utilization decreased significantly during the Pan-Mor (-59%) and Pan-Pre-Vax (-9%) phases compared to the Pre-Pan and subsequently increased during Pan-Vax (+6%) and Pan-Post-Vax (-1%) periods. Over 70% of STU transitioned to HSAT, and its usage surged five months after the vaccine Introduction. Conclusion Sleep testing services utilization recovered differentially during the pandemic (PSG vs HSAT), including a surge in HSAT utilization post-vaccination.
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Affiliation(s)
- Amin Ramezani
- VA's Health Services Research and Development Service (HSR&D), Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, 77030, USA
- Big Data Scientist Training Enhancement Program, VA Office of Research and Development, Washington, DC, 20420, USA
- VA Quality Scholars Coordinating Center, Iquest, Michael E. DeBakey VA Medical Center, Houston, TX, 77030, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Amir Sharafkhaneh
- VA's Health Services Research and Development Service (HSR&D), Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, 77030, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Ahmed S BaHammam
- Department of Medicine, College of Medicine, University Sleep Disorders Center, King Saud University, Riyadh, Saudi Arabia
- The Strategic Technologies Program of the National Plan for Sciences and Technology and Innovation in the Kingdom of Saudi Arabia, Riyadh, Saudi Arabia
| | - Samuel T Kuna
- Department of Medicine, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - Javad Razjouyan
- VA's Health Services Research and Development Service (HSR&D), Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, 77030, USA
- Big Data Scientist Training Enhancement Program, VA Office of Research and Development, Washington, DC, 20420, USA
- VA Quality Scholars Coordinating Center, Iquest, Michael E. DeBakey VA Medical Center, Houston, TX, 77030, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX, 77030, USA
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van der Kleij S, de Backer I, Hanraets B, Verbraecken J, Asin J. Effectiveness of remote monitoring in improving CPAP compliance and the impact of preexisting organisation of standard care: a randomised controlled trial. Sleep Breath 2024:10.1007/s11325-024-03042-z. [PMID: 38755506 DOI: 10.1007/s11325-024-03042-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 02/11/2024] [Accepted: 04/24/2024] [Indexed: 05/18/2024]
Abstract
PURPOSE : Continuous positive airway pressure (CPAP) is often the treatment of choice for obstructive sleep apnea (OSA). Short-term adherence and early perceived benefits are the best predictors of long-term adherence. The aim of this study was to determine the effect of telemonitoring in the first period of treatment with CPAP (auto-titrating PAP) on compliance and the long-term outcome. METHODS Patients aged between 18-75 years old with symptomatic severe OSA (apnea-hypopnea index (AHI) ≥ 30) requiring CPAP therapy were included in this single-blind, single-centre, randomised, controlled trial. They were divided into 2 groups (telemonitored standard clinical care versus standard clinical care without telemonitoring). RESULTS A total of 230 patients (115 patients/group) were included (mean age 54 ± 16.6 years, BMI 32.6 ± 5.4 kg/m2, ESS 13.1 ± 6.2, AHI 47.5 ± 14.8/hr). At week 10 compliance was similar in both groups (telemonitoring vs control 6:27 and 6:35 h, respectively, p = 0.57), as were AHI (2.4; 2.4/hr, p = 0.89) and ESS (5.8; 4.9, p = 0.22). The number of contacts of a patient with a healthcare professional was significantly higher during the follow-up from week 3 until week 10 (0.25; 0.13, p = 0.03). The number of patients who could be evaluated after 1 year was equally distributed in both groups (104; 104, p = 1.00), as were compliance (6:43; 6:49 h, p = 0.59) and residual AHI (1.9; 2.2/hr, p = 0.41). CONCLUSIONS In patients with severe OSA with standard intensive follow-up during the initial weeks of CPAP therapy and good compliance, telemonitoring did not improve CPAP compliance nor the clinical outcome in the short or long term. The practical consequences can be highly relevant for patients and healthcare professionals.
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Affiliation(s)
- Stephan van der Kleij
- Department of Pulmonary Medicine, Centre for Sleep Medicine, Amphia Hospital, Postbus 90158, 4800 RK, Breda, The Netherlands.
- Centre for Home Ventilation, Erasmus MC, Postbus 2040, 3000 CA, Rotterdam, The Netherlands.
| | - Ingrid de Backer
- Department of Pulmonary Medicine, Centre for Sleep Medicine, Amphia Hospital, Postbus 90158, 4800 RK, Breda, The Netherlands
| | - Barbara Hanraets
- Department of Pulmonary Medicine, Centre for Sleep Medicine, Amphia Hospital, Postbus 90158, 4800 RK, Breda, The Netherlands
- Department of Pulmonary Medicine, Centre for Home Ventilation, UMC Utrecht, Utrecht, The Netherlands
| | - Johan Verbraecken
- Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Jerryll Asin
- Department of Pulmonary Medicine, Centre for Sleep Medicine, Amphia Hospital, Postbus 90158, 4800 RK, Breda, The Netherlands.
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Bailly S, Mendelson M, Baillieul S, Tamisier R, Pépin JL. The Future of Telemedicine for Obstructive Sleep Apnea Treatment: A Narrative Review. J Clin Med 2024; 13:2700. [PMID: 38731229 PMCID: PMC11084346 DOI: 10.3390/jcm13092700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 04/24/2024] [Accepted: 04/30/2024] [Indexed: 05/13/2024] Open
Abstract
Obstructive sleep apnea is a common type of sleep-disordered breathing associated with multiple comorbidities. Nearly a billion people are estimated to have obstructive sleep apnea, which carries a substantial economic burden, but under-diagnosis is still a problem. Continuous positive airway pressure (CPAP) is the first-line treatment for OSAS. Telemedicine-based interventions (TM) have been evaluated to improve access to diagnosis, increase CPAP adherence, and contribute to easing the follow-up process, allowing healthcare facilities to provide patient-centered care. This narrative review summarizes the evidence available regarding the potential future of telemedicine in the management pathway of OSA. The potential of home sleep studies to improve OSA diagnosis and the importance of remote monitoring for tracking treatment adherence and failure and to contribute to developing patient engagement tools will be presented. Further studies are needed to explore the impact of shifting from teleconsultations to collaborative care models where patients are placed at the center of their care.
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Affiliation(s)
- Sébastien Bailly
- HP2 Laboratory, Inserm U1300, Grenoble Alps University, 38000 Grenoble, France; (S.B.); (M.M.); (S.B.); (R.T.)
| | - Monique Mendelson
- HP2 Laboratory, Inserm U1300, Grenoble Alps University, 38000 Grenoble, France; (S.B.); (M.M.); (S.B.); (R.T.)
| | - Sébastien Baillieul
- HP2 Laboratory, Inserm U1300, Grenoble Alps University, 38000 Grenoble, France; (S.B.); (M.M.); (S.B.); (R.T.)
| | - Renaud Tamisier
- HP2 Laboratory, Inserm U1300, Grenoble Alps University, 38000 Grenoble, France; (S.B.); (M.M.); (S.B.); (R.T.)
| | - Jean-Louis Pépin
- HP2 Laboratory, Inserm U1300, Grenoble Alps University, 38000 Grenoble, France; (S.B.); (M.M.); (S.B.); (R.T.)
- Laboratoire EFCR, CHU de Grenoble, CS10217, 38043 Grenoble, France
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Ssegonja R, Ljunggren M, Sampaio F, Tegelmo T, Theorell-Haglöw J. Economic evaluation of telemonitoring as a follow-up approach for patients with obstructive sleep apnea syndrome starting treatment with continuous positive airway pressure. J Sleep Res 2024; 33:e13968. [PMID: 37337981 DOI: 10.1111/jsr.13968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/15/2023] [Accepted: 06/05/2023] [Indexed: 06/21/2023]
Abstract
Telemonitoring of obstructive sleep apnea patients is increasingly being adopted though its cost-effectiveness evidence base is scanty. This study investigated whether telemonitoring is a cost-effective strategy compared with the standard follow-up in patients with obstructive sleep apnea who are starting continuous positive airway pressure treatment. In total, 167 obstructive sleep apnea patients were randomised into telemonitoring (n = 79) or standard follow-up (n = 88), initiated continuous positive airway pressure treatment, and were followed up for 6 months. The frequencies of healthcare contacts, related costs (in USD 2021 prices), treatment effect and compliance were compared between the follow-up approaches using generalised linear models. The cost effectiveness analysis was conducted from a healthcare perspective and the results presented as cost per avoided extra clinic visit. Additionally, patient satisfaction between the two approaches was explored. The analysis showed no baseline differences. At follow-up, there was no significant difference in treatment compliance, and the mean residual apnea-hypoapnea index. There was no difference in total visits, adjusted incidence rate ratio 0.87 (0.72-1.06). Participants in the telemonitoring arm made eight times more telephone visits, 8.10 (5.04-13.84), and about 73% fewer physical healthcare visits 0.27 (0.20-0.36). This translated into significantly lower total costs for the telemonitoring approach compared with standard follow-up, -192 USD (-346 to -41). The form of follow-up seemed to have no impact on the extent of patient satisfaction. These results demonstrate the telemonitoring of patients with obstructive sleep apnea initiating continuous positive airway pressure treatment as a cost saving strategy and can be argued as a potential worthy investment.
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Affiliation(s)
- Richard Ssegonja
- Department of Medical Sciences, Respiratory, Allergy- and Sleep Medicine Research Unit, Uppsala University, Uppsala, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Mirjam Ljunggren
- Department of Medical Sciences, Respiratory, Allergy- and Sleep Medicine Research Unit, Uppsala University, Uppsala, Sweden
| | - Filipa Sampaio
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Tove Tegelmo
- Department of Medical Sciences, Respiratory, Allergy- and Sleep Medicine Research Unit, Uppsala University, Uppsala, Sweden
| | - Jenny Theorell-Haglöw
- Department of Medical Sciences, Respiratory, Allergy- and Sleep Medicine Research Unit, Uppsala University, Uppsala, Sweden
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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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Bottaz-Bosson G, Midelet A, Mendelson M, Borel JC, Martinot JB, Le Hy R, Schaeffer MC, Samson A, Hamon A, Tamisier R, Malhotra A, Pépin JL, Bailly S. Remote Monitoring of Positive Airway Pressure Data: Challenges, Pitfalls, and Strategies to Consider for Optimal Data Science Applications. Chest 2023; 163:1279-1291. [PMID: 36470417 PMCID: PMC10258439 DOI: 10.1016/j.chest.2022.11.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 11/06/2022] [Accepted: 11/18/2022] [Indexed: 12/03/2022] Open
Abstract
Over recent years, positive airway pressure (PAP) remote monitoring has transformed the management of OSA and produced a large amount of data. Accumulated PAP data provide valuable and objective information regarding patient treatment adherence and efficiency. However, the majority of studies that have analyzed longitudinal PAP remote monitoring have summarized data trajectories in static and simplistic metrics for PAP adherence and the residual apnea-hypopnea index by the use of mean or median values. The aims of this article are to suggest directions for improving data cleaning and processing and to address major concerns for the following data science applications: (1) conditions for residual apnea-hypopnea index reliability, (2) lack of standardization of indicators provided by different PAP models, (3) missing values, and (4) consideration of treatment interruptions. To allow fair comparison among studies and to avoid biases in computation, PAP data processing and management should be conducted rigorously with these points in mind. PAP remote monitoring data contain a wealth of information that currently is underused in the field of sleep research. Improving the quality and standardizing data handling could facilitate data sharing among specialists worldwide and enable artificial intelligence strategies to be applied in the field of sleep apnea.
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Affiliation(s)
- Guillaume Bottaz-Bosson
- Laboratoire HP2, U1300 Inserm, University Grenoble Alpes, Grenoble, France; Jean Kuntzmann Laboratory, University Grenoble Alpes, Grenoble, France
| | - Alphanie Midelet
- Laboratoire HP2, U1300 Inserm, University Grenoble Alpes, Grenoble, France; Probayes, Montbonnot-Saint-Martin, France
| | - Monique Mendelson
- Laboratoire HP2, U1300 Inserm, University Grenoble Alpes, Grenoble, France
| | - Jean-Christian Borel
- Laboratoire HP2, U1300 Inserm, University Grenoble Alpes, Grenoble, France; AGIR à dom HomeCare Charity, Meylan, France
| | - Jean-Benoît Martinot
- Sleep Laboratory, CHU UCL Namur Site Sainte-Elisabeth, Namur, Belgium; Institute of Experimental and Clinical Research, UCL, Bruxelles Woluwe, Belgium
| | | | | | - Adeline Samson
- Jean Kuntzmann Laboratory, University Grenoble Alpes, Grenoble, France
| | - Agnès Hamon
- Jean Kuntzmann Laboratory, University Grenoble Alpes, Grenoble, France
| | - Renaud Tamisier
- Laboratoire HP2, U1300 Inserm, University Grenoble Alpes, Grenoble, France
| | - Atul Malhotra
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California San Diego, La Jolla, CA
| | - Jean-Louis Pépin
- Laboratoire HP2, U1300 Inserm, University Grenoble Alpes, Grenoble, France
| | - Sébastien Bailly
- Laboratoire HP2, U1300 Inserm, University Grenoble Alpes, Grenoble, France.
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Alsaif SS, Kelly JL, Little S, Pinnock H, Morrell MJ, Polkey MI, Murphie P. Virtual consultations for patients with obstructive sleep apnoea: a systematic review and meta-analysis. Eur Respir Rev 2022; 31:31/166/220180. [PMID: 36517048 PMCID: PMC9879338 DOI: 10.1183/16000617.0180-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/01/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The coronavirus disease 2019 pandemic has accelerated the adoption of virtual care strategies for the management of patients with obstructive sleep apnoea/hypopnoea syndrome (OSAHS). RESEARCH QUESTION What is the effectiveness of virtual consultations compared to in-person consultations for the management of continuous positive airway pressure (CPAP) therapy in adult patients with OSAHS? METHODS A systematic review and meta-analysis (PROSPERO; CRD42022297532) based on six electronic databases plus manually selected journals was conducted in January 2022. Two researchers independently selected, quality appraised and extracted data. The co-primary outcomes were patient-reported sleepiness, assessed by the Epworth Sleepiness Scale (ESS), and reported cost-effectiveness. RESULTS 12 studies (n=1823 adults) were included in the review. Seven studies (n=1089) were included in the meta-analysis which showed no difference in the magnitude of improvement in patient-reported sleepiness scores between virtual and in-person consultations (mean difference -0.39, 95% CI -1.38-0.60; p=0.4), although ESS scores improved in both groups. Virtual care strategies modestly increased CPAP therapy adherence and were found to be less costly than in-person care strategies in the three Spanish trials that reported cost-effectiveness. CONCLUSION The findings of this review suggest that virtual care delivered by telephone or video consultations is as effective as in-person consultations for improving subjective sleepiness in patients with OSAHS treated with CPAP. This clinical management strategy may also improve CPAP adherence without increasing the costs, supporting its potential as a follow-up management strategy, where patients prefer this approach.
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Affiliation(s)
- Sulaiman S. Alsaif
- National Heart and Lung Institute, Imperial College London, London, UK,Royal Brompton Hospital, Guy's and St Thomas’ NHS Foundation Trust, London, UK,Rehabilitation Health Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia,Corresponding author: Sulaiman S. Alsaif ()
| | - Julia L. Kelly
- National Heart and Lung Institute, Imperial College London, London, UK,Royal Brompton Hospital, Guy's and St Thomas’ NHS Foundation Trust, London, UK
| | - Stuart Little
- Department of Respiratory Medicine, NHS Dumfries and Galloway, Dumfries, UK
| | - Hilary Pinnock
- Allergy and Respiratory Research Group, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Mary J. Morrell
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Michael I. Polkey
- National Heart and Lung Institute, Imperial College London, London, UK,Royal Brompton Hospital, Guy's and St Thomas’ NHS Foundation Trust, London, UK,Sleep and Ventilation Services, Raigmore Hospital, Inverness, UK
| | - Phyllis Murphie
- Modernising Patients Pathways Programme, National Centre for Sustainable Delivery, Glasgow, UK
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Fietze I, Laharnar N, Bargiotas P, Basoglu OK, Dogas Z, Drummond M, Fanfulla F, Gislason T, Gouveris H, Grote L, Hein H, Jennum P, Joppa P, van Kralingen K, Kvamme JA, Lombardi C, Ludka O, Mallin W, Marrone O, McNicholas WT, Mihaicuta S, Montserrat J, Pillar G, Pataka A, Randerath W, Riha RL, Roisman G, Saaresranta T, Schiza SE, Sliwinski P, Svaza J, Steiropoulos P, Tamisier R, Testelmans D, Trakada G, Verbraecken J, Zablockis R, Penzel T. Management of obstructive sleep apnea in Europe - A 10-year follow-up. Sleep Med 2022; 97:64-72. [PMID: 35724441 DOI: 10.1016/j.sleep.2022.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 06/02/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE In 2010, a questionnaire-based study on obstructive sleep apnea (OSA) management in Europe identified differences regarding reimbursement, sleep specialist qualification, and titration procedures. Now, 10 years later, a follow-up study was conducted as part of the ESADA (European Sleep Apnea Database) network to explore the development of OSA management over time. METHODS The 2010 questionnaire including questions on sleep diagnostic, reimbursement, treatment, and certification was updated with questions on telemedicine and distributed to European Sleep Centers to reflect European OSA management practice. RESULTS 26 countries (36 sleep centers) participated, representing 20 ESADA and 6 non-ESADA countries. All 21 countries from the 2010 survey participated. In 2010, OSA diagnostic procedures were performed mainly by specialized physicians (86%), whereas now mainly by certified sleep specialists and specialized physicians (69%). Treatment and titration procedures are currently quite homogenous, with a strong trend towards more Autotitrating Positive Airway Pressure treatment (in hospital 73%, at home 62%). From 2010 to 2020, home sleep apnea testing use increased (76%-89%) and polysomnography as sole diagnostic procedure decreased (24%-12%). Availability of a sleep specialist qualification increased (52%-65%) as well as the number of certified polysomnography scorers (certified physicians: 36%-79%; certified technicians: 20%-62%). Telemedicine, not surveyed in 2010, is now in 2020 used in diagnostics (8%), treatment (50%), and follow-up (73%). CONCLUSION In the past decade, formal qualification of sleep center personnel increased, OSA diagnostic and treatment procedures shifted towards a more automatic approach, and telemedicine became more prominent.
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Affiliation(s)
- Ingo Fietze
- Interdisciplinary Center of Sleep Medicine, Charité - Universitätsmedizin Berlin, Germany; Department of Medicine, The Fourth People' Hospital of Guangyuan City, China; The Federal State Autonomous Educational Institution of Higher Education I. M. Sechenov, First Moscow State Medical University of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - Naima Laharnar
- Interdisciplinary Center of Sleep Medicine, Charité - Universitätsmedizin Berlin, Germany.
| | - Panagiotis Bargiotas
- Sleep and Motion Laboratory, Medical School, University of Cyprus, Nicosia, Cyprus
| | - Ozen K Basoglu
- Department of Chest Diseases, Ege University, Faculty of Medicine, Izmir, Turkey
| | - Zoran Dogas
- Sleep Medicine Center, Department of Neuroscience, University of Split, School of Medicine, Split, Croatia
| | - Marta Drummond
- Sleep and Non-Invasive Ventilation Unit, Hospital São João, Medicine Faculty of Porto University, Porto, Portugal
| | - Francesco Fanfulla
- Respiratory Function and Sleep Unit, Clinical Scientific Institutes Maugeri IRCCS, Pavia, Italy
| | - Thorarinn Gislason
- Medical Faculity, University of Iceland, Reykjavik, Iceland; Landspitali University Hospital, Reykjavik, Iceland
| | - Haralampos Gouveris
- Sleep Medicine Center & Department of Otolaryngology, University Medical Center, Mainz, Germany
| | - Ludger Grote
- Centre for Sleep and Wake Disorders, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Holger Hein
- Sleep Disorders Center, Reinbek/Geesthacht, Germany
| | - Poul Jennum
- Dansk Center for Sovnmedicin, Klinisk neurofysiologisk afdeling, Rigshospitalet, Glostrup, Denmark
| | - Pavol Joppa
- Department of Respiratory Medicine and Tuberculosis, Faculty of Medicine, P.J.Safarik University and L. Pasteur University Hospital, Kosice, Slovakia
| | | | | | - Carolina Lombardi
- Sleep Disorders Center, Dept. Medicine and Surgery, University of Milano-Bicocca & Instituto Auxologico Italiano, IRCCS, Dept. of Cardiology, S. Luca Hospital, Milan, Italy
| | - Ondrej Ludka
- Dep. of Internal Medicine, Geriatrics and Practical Medicine, University Hospital Brno and Faculty Medicine, Masaryk University, Brno, Czech Republic
| | - Wolfgang Mallin
- LKH Graz II, Standort Enzenbach, Gratwein - Strassengel, Austria
| | - Oreste Marrone
- CNR Institute for Research and Biomedical Innovation, Palermo, Italy
| | - Walter T McNicholas
- Department of Respiratory and Sleep Medicine, St. Vincent's Hospital Group, University College Dublin, Dublin, Ireland
| | - Stefan Mihaicuta
- Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | | | - Giora Pillar
- Sleep Clinic, Carmel Hospital, Technion Faculty of Medicine, Haifa, Israel
| | - Athanasia Pataka
- Respiratory Failure Unit, Aristotle University of Thessaloniki, G. Papanikolaou Hospital, Thessalonika, Greece
| | - Winfried Randerath
- Institute of Pneumology at the University of Cologne, Bethanien Hospital, Solingen, Germany
| | - Renata L Riha
- Department of Sleep Medicine, Royal Infirmary Edinburgh, Little France, UK
| | - Gabriel Roisman
- Sleep Disorders Center, Antoine-Beclere Hospital, Clamart, France
| | - Tarja Saaresranta
- Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital and Department of Pulmonary Diseases and Clinical Allegology, University of Turku, Turku, Finland
| | - Sophia E Schiza
- Sleep Disorders Unit, Department of Respiratory Medicine, Medical School, University of Crete, Crete, Greece
| | - Pawel Sliwinski
- 2nd Department of Respiratory Medicine, Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
| | - Juris Svaza
- Department of Anaesthesiology and Sleep Laboratory, Riga Stradins University, Riga, Latvia
| | - Paschalis Steiropoulos
- Sleep Unit, Department of Pneumonology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Renauld Tamisier
- Grenoble Alpes University, Inserm, CHU Grenoble Alpes, Grenoble, France
| | - Dries Testelmans
- Sleep Disorders Centre, University Hospital Gasthuisberg, Leuven, Belgium
| | - Georgia Trakada
- Department of Clinical Therapeutics, Division of Pulmonnary Medicine, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Johan Verbraecken
- Multidisciplinary Sleep Disorders Centre, University Hospital Antwerp and University of Antwerp, Edegem, Belgium
| | - Rolandas Zablockis
- Center of Pulmonology and Allergology, Clinic of Chest Diseases, Immunology and Allergology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Thomas Penzel
- Interdisciplinary Center of Sleep Medicine, Charité - Universitätsmedizin Berlin, Germany; Saratov State University, Saratov, Russia
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9
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van der Werf YD, Korostovtseva L, Khachatryan SG, Deleanu OC, Young P, Gnidovec-Stražišar B, Engstrøm M, Arnardottir ES, Verbraecken J, Pevernagie D. The history and role of the Assembly of National Sleep Societies (ANSS) within the European Sleep Research Society (ESRS). J Sleep Res 2022; 31:e13663. [PMID: 35707915 DOI: 10.1111/jsr.13663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 05/11/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Ysbrand D van der Werf
- Department of Anatomy and Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | | | - Samson G Khachatryan
- Department of Neurology and Neurosurgery, National Institute of Health, Yerevan, Armenia
| | - Oana C Deleanu
- University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Peter Young
- Department of Neurology, Medical Park Bad Feilnbach, Bad Feilnbach, Germany
| | | | - Morten Engstrøm
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; Department of Neurology and Clinical Neurophysiology, St Olavs Hospital, Trondheim, Norway
| | - Erna S Arnardottir
- Reykjavik University Sleep Institute School of Technology, Reykjavik University, Reykjavik, Iceland
| | - Johan Verbraecken
- Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium
| | - Dirk Pevernagie
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium.,Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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10
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Telemonitoring for the Follow-Up of Obstructive Sleep Apnea Patients Treated with CPAP: Accuracy and Impact on Therapy. SENSORS 2022; 22:s22072782. [PMID: 35408395 PMCID: PMC9002933 DOI: 10.3390/s22072782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 03/27/2022] [Accepted: 03/31/2022] [Indexed: 12/28/2022]
Abstract
Continuous positive airway pressure (CPAP) telemonitoring (TMg) has become widely implemented in routine clinical care. Objective measures of CPAP compliance, residual respiratory events, and leaks can be easily monitored, but limitations exist. This review aims to assess the role of TMg in CPAP-treated obstructive sleep apnea (OSA) patients. We report recent data related to the accuracy of parameters measured by CPAP and try to determine the role of TMg in CPAP treatment follow-up, from the perspective of both healthcare professionals and patients. Measurement and accuracy of CPAP-recorded data, clinical management of these data, and impacts of TMg on therapy are reviewed in light of the current literature. Moreover, the crucial questions of who and how to monitor are discussed. TMg is a useful tool to support, fine-tune, adapt, and control both CPAP efficacy and compliance in newly-diagnosed OSA patients. However, clinicians should be aware of the limits of the accuracy of CPAP devices to measure residual respiratory events and leaks and issues such as privacy and cost-effectiveness are still a matter of concern. The best methods to focus our efforts on the patients who need TMg support should be properly defined in future long-term studies.
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11
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Using Telemedicine to Monitor the Patient with Chronic Respiratory Failure. Life (Basel) 2021; 11:life11111113. [PMID: 34832989 PMCID: PMC8620445 DOI: 10.3390/life11111113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/10/2021] [Accepted: 10/19/2021] [Indexed: 11/30/2022] Open
Abstract
Background: Advances in management have improved mortality of individuals with chronic respiratory failure (CRF), leading to an increase in need for long-term oxygen therapy and/or ventilatory support. These individuals require frequent visits and monitoring of their physiological parameters as well as of the functioning of their devices, such as ventilators or oxygen concentrators. Telemedicine is a clinical application of Information Communication Technology connecting patients to specialised care consultants. This narrative review aims to explore the current available telemonitoring options for individuals with CRF and reported or potential results. Methods: The research focused on EMBASE, CINALH, PubMed, and Scopus databases. Papers published between 2003 and 2021 in English were considered. Results: Different sensors, transmission devices and systems, and interventions are used with promising but not conclusive clinical results. However, legal problems are still unsolved, and economic advantages for health care systems, although potentially high, are still under debate. Conclusions: Telemonitoring systems for individuals with CRF are increasingly used; with promising results still to be clarified, legal, economical and organisational issues must be defined.
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