Experience with over 10,000 sleep telemedicine visits for diagnosis and treatment of OSAS

ABSTRACT

Introduction: Since March 2020 BlueSleep has completed over 10,000 telemedicine consultations for diagnosis and treatment of sleep apnea exclusively by real-time telemedicine consultations using HIPAA-compliant video conferencing. Materials and Methods: This is a retrospective chart review of all virtual consultations performed between March 13, 2020 and December 31, 2021 at the BlueSleep center. This period coincided with the lockdown in New York City because of the COVID19 Pandemic. 10,171 telemedicine consultations were performed both for new and existing patients. No patients under the age of 18 were evaluated. The median patient age was 40 years old;2,412 males, 1,098 females. Diagnosis of sleep apnea was performed with disposable single-night or multi-night Home Sleep Tests (HST) with WatchaptOne (Itamar Medical) or Nightowl (Ectosense). Patients were given instructions for HSTs via asynchronous videos. HST data was transmitted to a portal for scoring and interpretation. Follow-up visit was by telemedicine, and treatment options including oral appliance therapy and CPAP were discussed. Surgical options were not available during the lockdown. If oral appliance therapy was chosen by the patient, a virtual visit with a dental professional was scheduled before sending a home impression kit. Home impressions were guided in real time with a dental professional. Dental impressions were submitted to the dental labs for fabrication of Mandibular Advancement Devices (MAD), and sent to the patient for a virtual home delivery by the dental professionals. A follow-up virtual visit was scheduled after the 4-week titration period, and depending on subjective results of decreased snoring and decreased daytime sleepiness, the patient was then instructed to repeat a HST for efficacy evaluation. If the patient chose CPAP, CPAP was shipped to the home, and a follow-up visit was scheduled for a virtual set-up visit, followed by compliance visits. All patients were scheduled for continuous telemedicine follow-up visits. Results: 10,171 visits were completed including first and follow-up visits. A total of 289 single-night and 2,275 multi-night HSTs were performed. 2,348 patients were diagnosed with OSA. 36% with mild OSA, 41% of patients with moderate OSA, and 23% with severe OSA. 1,163 had no OSA. 53% of patients were treated with OAT, 20% with CPAP. 271 patients were treated for primary snoring. 256 patients were treated for insomnia. 31 patients were diagnosed with Narcolepsy, and 636 patients were diagnosed with "other". Conclusions: A fully virtual model for diagnosis and treatment for obstructive sleep apnea and other sleep disorders is feasible and desirable. Telemedicine allows greater convenience (less time lost from work), and availability (greater geographic availability), and is a lower cost option. Acknowledgements We wish to thank the entire BlueSleep staff that has helped make our service to patients available during the Covid 19 Pandemic.