Virtual consultations for patients with obstructive sleep apnoea: a systematic review and meta-analysis.

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.

Telemedicine and virtual respiratory care in the era of COVID-19.

The World Health Organization defines telemedicine as "an interaction between a healthcare provider and a patient when the two are separated by distance". The coronavirus disease 2019 (COVID-19) pandemic has forced a dramatic shift to telephone and video consulting for follow-up and routine ambulatory care for reasons of infection control. Short message service ("text") messaging has proved a useful adjunct to remote consulting, allowing the transfer of photographs and documents. Maintaining the care of noncommunicable diseases is a core component of pandemic preparedness and telemedicine has developed to enable (for example) remote monitoring of sleep apnoea, telemonitoring of COPD, digital support for asthma self-management and remote delivery of pulmonary rehabilitation. There are multiple exemplars of telehealth instigated rapidly to provide care for people with COVID-19, to manage the spread of the pandemic or to maintain safe routine diagnostic or treatment services. Despite many positive examples of equivalent functionality and safety, there remain questions about the impact of remote delivery of care on rapport and the longer term impact on patient/professional relationships. Although telehealth has the potential to contribute to universal health coverage by providing cost-effective accessible care, there is a risk of increasing social health inequalities if the "digital divide" excludes those most in need of care. As we emerge from the pandemic, the balance of remote versus face-to-face consulting, and the specific role of digital health in different clinical and healthcare contexts will evolve. What is clear is that telemedicine in one form or another will be part of the "new norm".

Remote consulting with telemonitoring of continuous positive airway pressure usage data for the routine review of people with obstructive sleep apnoea hypopnoea syndrome: A systematic review.

INTRODUCTION: Telehealth has the potential to offer more convenient care and reduce travel. We aimed to systematically review studies that assessed the effectiveness of teleconsultation plus telemonitoring in the review of people with obstructive sleep apnoea hypopnoea syndrome receiving continuous positive airway pressure therapy versus face-to-face care. METHODS: Following Cochrane methodology, we searched 10 electronic databases (November 2015), trial registries, and reference lists of included studies, for trials testing interventions that combined remote consultations with telemonitoring of usage/continuous positive airway pressure data. Outcomes measures were: proportion reviewed, continuous positive airway pressure adherence, symptom control, and satisfaction/acceptability and cost effectiveness. RESULTS: From 362 potentially relevant papers, we identified five randomised controlled trials ( n = 269 patients): four from North America and one from Spain. Risk of bias was moderate in one, and moderate/high in four trials. Two trials reported number/duration of reviews with inconsistent results. The teleconsultation/telemonitoring improved continuous positive airway pressure adherence in two trials ( n = 19; n = 75); two ( n = 114 and n = 75) reported no between-groups differences. Two studies, both at moderate/high risk of bias, showed no between-group difference in the Epworth Sleepiness Score. Satisfaction was generally reported positively in all five trials; one trial reported that the teleconsultation/telemonitoring patients were 'more likely to continue' with continuous positive airway pressure therapy treatment. One study reported teleconsultation/telemonitoring as cost effective. DISCUSSION: The evidence for teleconsultation/telemonitoring in continuous positive airway pressure users is limited; however, no safety concerns have been raised. Adequately powered, well-designed trials are needed to establish whether real-time telemonitoring and remote teleconsultation is a clinically and cost effective option for people using continuous positive airway pressure therapy.

Defining the Core Components of a Clinical Review of People Using Continuous Positive Airway Pressure Therapy to Treat Obstructive Sleep Apnea: An International e-Delphi Study.

STUDY OBJECTIVES: Guidelines recommend regular review of individuals using continuous positive airway pressure (CPAP) to treat obstructive sleep apnea but do not agree on the core components and frequency. We aimed to achieve consensus on essential components and frequency of review. METHODS: We used an e-Delphi approach, recruiting a multidisciplinary international expert panel to identify components based on a list compiled from guidelines and to score these on a scale 1 to 5 over three rounds. Consensus was defined as ≥ 75% agreement for scores of 4 or higher. Free-text comments were thematically analyzed. RESULTS: Forty participants completed 3 rounds scoring 36 potential components. Seventeen components achieved consensus: treatment acceptability, sleep quality, symptom resolution (including reduction in apnea-hypopnea index), assessment of sleepiness (including when driving), technical CPAP issues (mask fit/humidification/cleaning/filters), recording CPAP adherence, and quality of life. Participants suggested 12 to 18 monthly reviews (more frequent when commencing CPAP) or "on demand." Free-text comments highlighted that reviews should be multidisciplinary, flexible (including telehealth), and focus on symptom control. CONCLUSIONS: We mapped 17 prioritized components to a suggested template that may support clinical reviews. Reviews should be flexible, frequently in the early stages of commencing CPAP, shifting to "on demand" and/or remote follow-up for maintenance. Our findings may inform future guideline recommendations for reviewing CPAP users.

Self-fill oxygen technology: benefits for patients, healthcare providers and the environment.

"Non-delivery" home oxygen technologies that allow self-filling of ambulatory oxygen cylinders are emerging. They can offer a relatively unlimited supply of ambulatory oxygen in suitably assessed people who require long-term oxygen therapy (LTOT), providing they can use these systems safely and effectively. This allows users to be self-sufficient and facilitates longer periods of time away from home. The evolution and evidence base of this technology is reported with the experience of a national service review in Scotland (UK). Given that domiciliary oxygen services represent a significant cost to healthcare providers globally, these systems offer potential cost savings, are appealing to remote and rural regions due to the avoidance of cylinder delivery and have additional lower environmental impact due to reduced fossil fuel consumption and subsequently reduced carbon emissions. Evidence is emerging that self-fill/non-delivery oxygen systems can meet the ambulatory oxygen needs of many patients using LTOT and can have a positive impact on quality of life, increase time spent away from home and offer significant financial savings to healthcare providers. EDUCATIONAL AIMS: Provide update for oxygen prescribers on options for home oxygen provision.Provide update on the evidence base for available self-fill oxygen technologies.Provide and update for healthcare commissioners on the potential cost-effective and environmental benefits of increased utilisation of self-fill oxygen systems.