Remote Monitoring for Prediction and Management of Acute Exacerbations in Chronic Obstructive Pulmonary Disease (AECOPD).

The progression of chronic obstructive pulmonary disease (COPD) is characterized by episodes of acute exacerbation (AECOPD) of symptoms, decline in respiratory function, and reduction in quality-of-life increasing morbi-mortality and often requiring hospitalization. Exacerbations can be triggered by environmental exposures, changes in lifestyle, and/or physiological and psychological factors to greater or lesser extents depending on the individual's COPD phenotype. The prediction and early detection of an exacerbation might allow patients and physicians to better manage the acute phase. We summarize the recent scientific data on remote telemonitoring (TM) for the prediction and management of acute exacerbations in COPD patients. We discuss the components of remote monitoring platforms, including the integration of environmental monitoring data; patient reported outcomes collected via interactive Smartphone apps, with data from wearable devices that monitor physical activity, heart rate, etc.; and data from medical devices such as connected non-invasive ventilators. We consider how telemonitoring and the deluge of data it potentially generates could be combined with electronic health records to provide personalized care and multi-disease management for COPD patients.

Diagnosis of Sleep Apnoea Using a Mandibular Monitor and Machine Learning Analysis: One-Night Agreement Compared to in-Home Polysomnography.

Background: The capacity to diagnose obstructive sleep apnoea (OSA) must be expanded to meet an estimated disease burden of nearly one billion people worldwide. Validated alternatives to the gold standard polysomnography (PSG) will improve access to testing and treatment. This study aimed to evaluate the diagnosis of OSA, using measurements of mandibular movement (MM) combined with automated machine learning analysis, compared to in-home PSG. Methods: 40 suspected OSA patients underwent single overnight in-home sleep testing with PSG (Nox A1, ResMed, Australia) and simultaneous MM monitoring (Sunrise, Sunrise SA, Belgium). PSG recordings were manually analysed by two expert sleep centres (Grenoble and London); MM analysis was automated. The Obstructive Respiratory Disturbance Index calculated from the MM monitoring (MM-ORDI) was compared to the PSG (PSG-ORDI) using intraclass correlation coefficient and Bland-Altman analysis. Receiver operating characteristic curves (ROC) were constructed to optimise the diagnostic performance of the MM monitor at different PSG-ORDI thresholds (5, 15, and 30 events/hour). Results: 31 patients were included in the analysis (58% men; mean (SD) age: 48 (15) years; BMI: 30.4 (7.6) kg/m2). Good agreement was observed between MM-ORDI and PSG-ORDI (median bias 0.00; 95% CI -23.25 to + 9.73 events/hour). However, for 15 patients with no or mild OSA, MM monitoring overestimated disease severity (PSG-ORDI < 5: MM-ORDI mean overestimation + 5.58 (95% CI + 2.03 to + 7.46) events/hour; PSG-ORDI > 5-15: MM-ORDI overestimation + 3.70 (95% CI -0.53 to + 18.32) events/hour). In 16 patients with moderate-severe OSA (n = 9 with PSG-ORDI 15-30 events/h and n = 7 with a PSG-ORD > 30 events/h), there was an underestimation (PSG-ORDI > 15: MM-ORDI underestimation -8.70 (95% CI -28.46 to + 4.01) events/hour). ROC optimal cut-off values for PSG-ORDI thresholds of 5, 15, 30 events/hour were: 9.53, 12.65 and 24.81 events/hour, respectively. These cut-off values yielded a sensitivity of 88, 100 and 79%, and a specificity of 100, 75, 96%. The positive predictive values were: 100, 80, 95% and the negative predictive values 89, 100, 82%, respectively. Conclusion: The diagnosis of OSA, using MM with machine learning analysis, is comparable to manually scored in-home PSG. Therefore, this novel monitor could be a convenient diagnostic tool that can easily be used in the patients' own home. Clinical Trial Registration: https://clinicaltrials.gov, identifier NCT04262557.

Detecting COVID-19 and other respiratory infections in obstructive sleep apnoea patients through CPAP device telemonitoring

Objective The earliest possible detection of individuals with COVID-19 has been essential to curb the spread of infection. Existing digital tools have been scaled up to address this issue. Every night telemonitoring data on continuous positive airway pressure (CPAP) device use, the first-line therapy for obstructive sleep apnoea (OSA), is collected worldwide. We asked whether the changes in CPAP adherence patterns of might constitute an alert for COVID-19. Methods We analysed preliminary results of telemonitoring data, recorded between February 1 and April 30, 2020, on OSA patients followed by our sleep clinics and diagnosed with COVID-19. Results CPAP telemonitoring data from the first 19 patients diagnosed with COVID-19 showed a clear decrease or halt in adherence in the 20 days immediately preceding COVID-19 diagnosis compared to an earlier period (p < 0.01). Conclusion Patterns of continuous positive airway pressure device use by obstructive sleep apnoea patients collected through telemonitoring can indicate the onset of COVID-19 symptoms. Existing telemonitoring platforms could be immediately used to screen for COVID-19, and for other respiratory infections, in this large at-risk population.

The Impact of the COVID-19 Lockdown on Weight Loss and Body Composition in Subjects with Overweight and Obesity Participating in a Nationwide Weight-Loss Program: Impact of a Remote Consultation Follow-Up-The CO-RNPC Study.

The aim of this study was to assess the impact of the nationwide total lockdown (LD) in France on weight loss and body composition modifications in subjects participating in a weight loss program and to evaluate the impact of remote consultations on participants' adherence to the weight loss program. The CO-RNPC study was a prospective multicentre cohort study including participants undergoing a two to six months program. The rate of weight loss in kg/week was computed before (15 days), during (99 days) and after LD (15 days). In the 1550 completing participants, body weight decreased from 87.1 kg [IQR 77.0; 100.2] to 82.3 kg [72.1; 94.3] resulting in a difference of -4.79 kg [-4.48; -5.10] (p < 0.01), with a corresponding reduction in waist circumference by 4 cm ([0; 9], p < 0.01). The median weight loss was 4.4 kg [0.5; 9.4] in those who used remote consultations, and 1.4 kg [0.8; 5.7] in the no remote consultation group (p < 0.01). In this large prospective cohort, we observed that the rate of weight loss was reduced during LD. This reduction was counterbalanced in participants involved in a remote consultation follow-up with a dose-effect response based on the number of remote consultations.

Detecting COVID-19 and other respiratory infections in obstructive sleep apnoea patients through CPAP device telemonitoring.

OBJECTIVE: The earliest possible detection of individuals with COVID-19 has been essential to curb the spread of infection. Existing digital tools have been scaled up to address this issue. Every night telemonitoring data on continuous positive airway pressure (CPAP) device use, the first-line therapy for obstructive sleep apnoea (OSA), is collected worldwide. We asked whether the changes in CPAP adherence patterns of might constitute an alert for COVID-19. METHODS: We analysed preliminary results of telemonitoring data, recorded between February 1 and April 30, 2020, on OSA patients followed by our sleep clinics and diagnosed with COVID-19. RESULTS: CPAP telemonitoring data from the first 19 patients diagnosed with COVID-19 showed a clear decrease or halt in adherence in the 20 days immediately preceding COVID-19 diagnosis compared to an earlier period (p < 0.01). CONCLUSION: Patterns of continuous positive airway pressure device use by obstructive sleep apnoea patients collected through telemonitoring can indicate the onset of COVID-19 symptoms. Existing telemonitoring platforms could be immediately used to screen for COVID-19, and for other respiratory infections, in this large at-risk population.

Greatest changes in objective sleep architecture during COVID-19 lockdown in night owls with increased REM sleep.

STUDY OBJECTIVES: The COVID-19 pandemic has had dramatic effects on society and people's daily habits. In this observational study, we recorded objective data on sleep macro- and microarchitecture repeatedly over several nights before and during the COVID-19 government-imposed lockdown. The main objective was to evaluate changes in patterns of sleep duration and architecture during home confinement using the pre-confinement period as a control. METHODS: Participants were regular users of a sleep-monitoring headband that records, stores, and automatically analyzes physiological data in real time, equivalent to polysomnography. We measured sleep onset duration, total sleep time, duration of sleep stages (N2, N3, and rapid eye movement [REM]), and sleep continuity. Via the user's smartphone application, participants filled in questionnaires on how lockdown changed working hours, eating behavior, and daily life at home. They also filled in the Insomnia Severity Index, reduced Morningness-Eveningness Questionnaire, and Hospital Anxiety and Depression Scale questionnaires, allowing us to create selected subgroups. RESULTS: The 599 participants were mainly men (71%) of median age 47 (interquartile range: 36-59). Compared to before lockdown, during lockdown individuals slept more overall (mean +3·83 min; SD: ±1.3), had less deep sleep (N3), more light sleep (N2), and longer REM sleep (mean +3·74 min; SD: ±0.8). They exhibited less weekend-specific changes, suggesting less sleep restriction during the week. Changes were most pronounced in individuals reporting eveningness preferences, suggesting relative sleep deprivation in this population and exacerbated sensitivity to societal changes. CONCLUSION: This unique dataset should help us understand the effects of lockdown on sleep architecture and on our health.

Continuous positive airway pressure-treated patients' behaviours during the COVID-19 crisis.

The #COVID19 pandemic has had limited impact on CPAP use by obstructive sleep apnoea patients. Mainly only those with suspected or proven COVID-19 stopped CPAP use, sometimes without a physician's advice, and were more likely to move to a separate bedroom. https://bit.ly/2RxQDZO.

Propositions Pour La Prise En Charge Des Troubles Du Sommeil Et De La Vigilance En Periode Epidemique Covid-19

RESUME Depuis mi-mars 2020, l’épidémie de COVID-19 a conduit à la suspension de la prise en charge des patients présentant des troubles du sommeil et de la vigilance. Bien qu’ayant rarement un caractère urgent, cette prise en charge ne peut être repoussée indéfiniment. Des propositions visant à établir les modalités de reprise progressive des activités de médecine du sommeil ont été élaborées grâce à la méthodologie CORE qui permet de dégager rapidement un consensus d’experts lorsque les données probantes sont insuffisantes. La réalisation d’explorations diagnostiques du sommeil et de la vigilance, doit être limitée aux patients pour lesquels la balance bénéfice-risque est favorable de manière indiscutable et lorsque les résultats sont susceptibles d’avoir un impact décisif sur une stratégie thérapeutique, en privilégiant la téléconsultation et les enregistrements ambulatoires. Le strict respect de la distanciation physique et des autres mesures barrière, le port d’équipement de protection par le personnel en fonction des tâches, l’utilisation de matériel à usage unique si possible, et des procédures rigoureuses de nettoyage et de désinfection de l’équipement et des locaux doit permettre de limiter les risques de transmission du SARS-CoV-2 entre le patient et les soignants. Les propositions du groupe d’experts sont valables au moment de leur publication mais seront bien entendu réévaluées et complétées très régulièrement en fonction de l’évolution des connaissances scientifiques et des recommandations des autorités de santé basées sur l’évolution de l’épidémie. SUMMARY Since mid-March 2020, the COVID-19 epidemic has led to the suspension of sleep clinic and sleep center operations. Although rarely urgent, sleep disorder management cannot be postponed indefinitely. Proposals to clarify the modalities for the gradual resumption of sleep medicine services have been developed using the CORE methodology, which allows for rapid expert consensus when the evidence-based data is weak. The performance of diagnostic sleep and alertness tests must be limited to patients for whom the benefit-risk balance is indisputably favorable and when the results are likely to have a decisive impact on a therapeutic strategy, with priority being given to teleconsultation and ambulatory recordings. Strict adherence to physical separation and other barrier measures, the use of protective equipment by staff and of single-use equipment whenever possible, and strict cleaning and disinfection procedures for equipment and premises should limit the risk of SARS-CoV-2 transmission between patient and staff members. The proposals of the expert group are valid at the time of their publication but will be re-evaluated and updated regularly according to the development of scientific knowledge and the recommendations of the health authorities based on the evolution of the epidemic.