Download PDF
Semin Respir Crit Care Med 2014; 35(05): 560-570
DOI: 10.1055/s-0034-1390069
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

A Telemedicine Program for Diagnosis and Management of Sleep-Disordered Breathing: The Fast-Track for Sleep Apnea Tele-Sleep Program

Max Hirshkowitz
1   Department of Medicine, Baylor College of Medicine, Houston, Texas
2   Sleep Disorders and Research Center, Michael E. DeBakey Veterans Affairs Medical Center, Pulmonary, Critical Care & Sleep Section, Houston, Texas
,
Amir Sharafkhaneh
1   Department of Medicine, Baylor College of Medicine, Houston, Texas
› Author Affiliations
Further Information

Publication History

Publication Date:
29 October 2014 (online)

    Permissions and Reprints

Abstract

The objective of this study was to facilitate access to sleep health care for veterans. We designed and implemented a Telehealth program for diagnosing and treating sleep-related breathing disorders (SRBDs). Building on our ongoing out-of-laboratory “Fast Track for Sleep Apnea” program, procedures were modified to accommodate remote operations. This Tele-sleep program was set up at the medical center's community-based outpatient clinics. Home sleep testing and positive airway pressure device technological advances enabled realizing this application for Telehealth. In addition to obtaining appropriated teleconferencing equipment, the program involved implementing systematic processes for (1) six types of clinic visits, (2) training remote-site personnel, (3) making recommendations for inventory management, and (4) evaluating patient satisfaction. Over the past year, we have updated and refined our procedures to optimize program performance and efficiency. To achieve the next step, that is, increasing program scale beyond its current state (e.g., to region-wide), we will need to further develop and formalize quality control indicators to more efficiently monitor operations. The program has helped relieve clinical load at the central sleep program, improved local access to sleep care for veterans, and improved patient satisfaction with health care for SRBDs.

Keywords

sleep apnea - home sleep testing - positive airway pressure - telehealth - tele-medicine
 

  • References

  • 1 Sanders MH, Givelber RJ. Overview of obstructive sleep apnoea in adults. In: Lee Chong, , ed. Sleep Disorders: A Brief Guide. Chichester, UK: John Wiley & Sons; 2007: 39-57
    Google Scholar
  • 2 Hirshkowitz M, Kryger MH. Monitoring techniques for evaluating suspected sleep-disordered breathing. In: Kryger MH, Roth T, Dement WC, , eds. Principles and Practice of Sleep Medicine, 4th ed. Philadelphia, PA: WB Saunders; 2005: 1378-1393
    CrossrefGoogle Scholar
  • 3 Collop NA, Anderson WM, Boehlecke B , et al; Portable Monitoring Task Force of the American Academy of Sleep Medicine. Clinical guidelines for the use of unattended portable monitors in the diagnosis of obstructive sleep apnea in adult patients. J Clin Sleep Med 2007; 3 (7) 737-747
    PubMedGoogle Scholar
  • 4 Littner M, Hirshkowitz M, Davila D , et al; Standards of Practice Committee of the American Academy of Sleep Medicine. Practice parameters for the use of auto-titrating continuous positive airway pressure devices for titrating pressures and treating adult patients with obstructive sleep apnea syndrome. An American Academy of Sleep Medicine report. Sleep 2002; 25 (2) 143-147
    PubMedGoogle Scholar
  • 5 Norris AC. (2002). Essentials of Telemedicine and Telecare. West Sussex, England; New York: John Wiley & Sons, Ltd;
    Google Scholar
  • 6 From Internet: The US Department of Health and Human Services Rural Outreach website. Available at: www.hrsa.gov/ruralhealth/about/telehealth/telehealth.html
    PubMedGoogle Scholar
  • 7 From Internet. Whole Systems Demonstrators: An Overview of Telecare and Telehealth. Updated 2009. . Available at: www.gov.uk/govrnment/uploads/system/uploads/attachment_data/file/215264/dh_131689.pdf
    Google Scholar
  • 8 From Internet: Telehealth Improves Access and Quality of Care for Alaska Natives. Agency for Healthcare Research and Quality. Updated 2013 . Available at: www.innovations.ahrq.gov/content.aspx?id-3932
    PubMedGoogle Scholar
  • 9 Kushida CA, Littner MR, Morgenthaler T , et al; Standards of Practice Committee of the American Academy of Sleep Medicine. Practice parameters for the indications for polysomnography and related procedures: an update for 2005. Sleep 2005; 28 (4) 499-521
    PubMedGoogle Scholar
  • 10 Littner M, Hirshkowitz M, Sharafkhaneh A, Goodnight-White S. Nonlaboratory assessment of sleep-related breathing disorders. Sleep Med Clin 2006; 1: 461-463
    CrossrefPubMedGoogle Scholar
  • 11 Hesselbacher S, Mattewal A, Hirshkowitz M, Sharafkhaneh A. Classification, technical specifications, and types of home sleep testing devices for sleep-disordered breathing. Sleep Med Clin 2011; 6 (3) 261-282
    CrossrefPubMedGoogle Scholar
  • 12 Sullivan CE, Issa FG, Berthon-Jones M, Eves L. Reversal of obstructive sleep apnoea by continuous positive airway pressure applied through the nares. Lancet 1981; 1 (8225) 862-865
    PubMedGoogle Scholar
  • 13 Hirshkowitz M, Sharafkhaneh A. Comparison of portable monitoring with laboratory polysomnography for diagnosing sleep-related breathing disorders: scoring and interpretation. Sleep Med Clin 2011; 6: 283-292
    CrossrefPubMedGoogle Scholar
  • 14 Chung F, Yegneswaran B, Liao P , et al. STOP questionnaire: a tool to screen patients for obstructive sleep apnea. Anesthesiology 2008; 108 (5) 812-821
    CrossrefPubMedGoogle Scholar
  • 15 Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP. Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med 1999; 131 (7) 485-491
    PubMedGoogle Scholar
  • 16 Maislin G, Pack AI, Kribbs NB , et al. A survey screen for prediction of apnea. Sleep 1995; 18 (3) 158-166
    PubMedGoogle Scholar