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CC BY-NC-ND 4.0 · Sleep Sci
DOI: 10.1055/s-0044-1782526
Original Article

An Alternative In-Home Protocol to Diagnose and Treat Obstructive Sleep Apnea

Tarcya L. G. Couto Patriota 
,
Rodrigo Pinto Pedrosa 
Funding The authors declare that the present study was funded by ResMed Healthcare Professional (San Diego, CA, United States).
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Abstract

Objective Obstructive sleep apnea (OSA) is a major public health problem of pandemic proportions. In-laboratory OSA diagnosis and continuous positive airway pressure (CPAP) titration are insufficient, considering the number of patients affected. Finding alternative ways to diagnose and treat OSA is mandatory, especially in this era of the coronavirus disease 2019 (COVID-19) pandemic. The present study aims to describe an alternative in-home protocol to diagnose and treat OSA.

Materials and Methods We enrolled consecutive patients aged ≥ 18 years with moderate/severe OSA, who underwent in-home type-III polysomnography and home-based titration with automatic CPAP, coupled with an oximetry sensor for 3 consecutive nights. Patients were remotely monitored for 90 days to evaluate CPAP compliance and the use of an engagement tool was encouraged.

Results We included 86 participants. The median time until the diagnosis was of one day. The mean time from the baseline visit until the acquisition and initiation of the CPAP therapy was of 33 (range: 17 to 52) days. Telemonitoring ensured good compliance in the first 30 (79.2%), 60 (76.3%) and 90 (74.3%) days, with an average daily use of 6.2 ± 1.4 h, 6.0 ± 1.4 h, and 6.0 ± 1.3 h respectively. About 1/3 of the patients used the engagement tool, and CPAP compliance was significantly higher among these patients compared with those who did not used the tool: 89.9% versus 73.5% (p < 0.002), 87.9% versus 70% (p < 0.003), and 86.6% versus 67.6% (p < 0.001) at 30, 60, and 90 days respectively.

Conclusion We demonstrated that an alternative in-home protocol to diagnose and treat OSA is effective, ensuring good CPAP compliance after 90 days. Telemonitoring and engagement tools could be strategies to improve CPAP compliance.

Keywords

obstructive sleep apnea - diagnosis - continuous positive airway pressure - compliance - telemonitoring


Publication History

Received: 13 April 2023

Accepted: 20 December 2023

Article published online:
09 April 2024

© 2024. Brazilian Sleep Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Berry RB, Budhiraja R, Gottlieb DJ. et al; American Academy of Sleep Medicine, Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. J Clin Sleep Med 2012; 8 (05) 597-619
    CrossrefPubMedGoogle Scholar
  • 2 Veasey SC, Rosen IM. Obstructive Sleep Apnea in Adults. N Engl J Med 2019; 380 (15) 1442-1449
    CrossrefPubMedGoogle Scholar
  • 3 Benjafield AV, Ayas NT, Eastwood PR. et al. Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis. Lancet Respir Med 2019; 7 (08) 687-698
    CrossrefPubMedGoogle Scholar
  • 4 McEvoy RD, Antic NA, Heeley E. et al; SAVE Investigators and Coordinators. CPAP for Prevention of Cardiovascular Events in Obstructive Sleep Apnea. N Engl J Med 2016; 375 (10) 919-931
    CrossrefPubMedGoogle Scholar
  • 5 Gonzaga C, Bertolami A, Bertolami M, Amodeo C, Calhoun D. Obstructive sleep apnea, hypertension and cardiovascular diseases. J Hum Hypertens 2015; 29 (12) 705-712
    CrossrefPubMedGoogle Scholar
  • 6 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. Portable Monitoring Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med 2007; 03 (07) 737-747 PubMed
    CrossrefGoogle Scholar
  • 7 Corral J, Sánchez-Quiroga MA, Carmona-Bernal C. et al; Spanish Sleep Network. Conventional polysomnography is not necessary for the management of most patients with suspected obstructive sleep apnea noninferiority, randomized controlled trial. Am J Respir Crit Care Med 2017; 196 (09) 1181-1190
    CrossrefPubMedGoogle Scholar
  • 8 Abuzaid AS, Al Ashry HS, Elbadawi A. et al. Meta-Analysis of Cardiovascular Outcomes With Continuous Positive Airway Pressure Therapy in Patients With Obstructive Sleep Apnea. Am J Cardiol 2017; 120 (04) 693-699
    CrossrefPubMedGoogle Scholar
  • 9 Mehrtash M, Bakker JP, Ayas N. Predictors of Continuous Positive Airway Pressure Adherence in Patients with Obstructive Sleep Apnea. Lung 2019; 197 (02) 115-121
    CrossrefPubMedGoogle Scholar
  • 10 Dusart C, Andre S, Mettay T, Bruyneel M. Telemonitoring for the Follow-Up of Obstructive Sleep Apnea Patients Treated with CPAP: Accuracy and Impact on Therapy. Vol. 22. Sensors.: MDPI; 2022
    Google Scholar
  • 11 Sateia MJ. International classification of sleep disorders-third edition: highlights and modifications. Chest 2014; 146 (05) 1387-1394
    CrossrefPubMedGoogle Scholar
  • 12 Andrade L, Paiva T. Ambulatory versus laboratory polysomnography in obstructive sleep apnea: Comparative assessment of quality, clinical efficacy, treatment compliance, and quality of life. J Clin Sleep Med 2018; 14 (08) 1323-1331
    CrossrefPubMedGoogle Scholar
  • 13 Pachito DV, Bagattini ÂM, Drager LF, Eckeli AL, Rocha A. Economic evaluation of CPAP therapy for obstructive sleep apnea: a scoping review and evidence map. Sleep Breath 2022; 26 (01) 17-30 . Springer Science and Business Media Deutschland GmbH
    CrossrefPubMedGoogle Scholar
  • 14 Pack AI. Does laboratory polysomnography yield better outcomes than home sleep testing? Yes. Vol. 148, Chest. American College of Chest Physicians;; 2015: 306-308
    Google Scholar
  • 15 Dzięciołowska-Baran E, Gawlikowska-Sroka A, Szczurowski J. Diagnosis of Sleep-Disordered Breathing in the Home Environment. In: Advances in Experimental Medicine and Biology. Springer; 2020: 107-12
    Google Scholar
  • 16 Kuna ST, Gurubhagavatula I, Maislin G. et al. Noninferiority of functional outcome in ambulatory management of obstructive sleep apnea. Am J Respir Crit Care Med 2011; 183 (09) 1238-1244
    CrossrefPubMedGoogle Scholar
  • 17 Berry RB, Sriram P. Auto-adjusting positive airway pressure treatment for sleep apnea diagnosed by home sleep testing. J Clin Sleep Med 2014; 10 (12) 1269-1275
    CrossrefPubMedGoogle Scholar
  • 18 Virk JS, Kotecha B. When continuous positive airway pressure (CPAP) fails. J Thorac Dis 2016; 8 (10) E1112-E1121 . AME Publishing Company
    CrossrefPubMedGoogle Scholar
  • 19 Hoet F, Libert W, Sanida C, Van den Broecke S, Bruyneel AV, Bruyneel M. Telemonitoring in continuous positive airway pressure-treated patients improves delay to first intervention and early compliance: a randomized trial. Sleep Med 2017; 39: 77-83
    CrossrefPubMedGoogle Scholar
  • 20 Turino C, de Batlle J, Woehrle H. et al. Management of continuous positive airway pressure treatment compliance using telemonitoring in obstructive sleep apnoea. Eur Respir J 2017; 49 (02) 1601128
    CrossrefPubMedGoogle Scholar
  • 21 Drager LF, Malhotra A, Yan Y. et al; medXcloud group. Adherence with positive airway pressure therapy for obstructive sleep apnea in developing vs. developed countries: a big data study. J Clin Sleep Med 2021; 17 (04) 703-709
    CrossrefPubMedGoogle Scholar