Patient experience of the use of continuous positive airway pressure for the treatment of obstructive sleep apnea with or without telemedicine during COVID-19: a qualitative approach.

STUDY OBJECTIVES: Continuous positive airway pressure (CPAP) is considered effective treatment for moderate-severe obstructive sleep apnea (OSA). Clinicians measure compliance to treatment by the number of hours CPAP is used per 24 hours. There have been very few studies examining the patients' lived experience of CPAP and the barriers to use. This study examined the patients' experience of OSA, CPAP use and treatment during COVID-19. METHODS: This CPAP patient experience qualitative study was part of a larger project. The overarching study was a three-armed nonblinded randomized controlled trial of patients on CPAP for treatment of OSA using standard care or one of two telemedicine interventions. Patients who had completed the RCT study were invited to be interviewed via telephone, about their OSA diagnosis, CPAP experiences, their experience of using telemedicine and the impact of SARS-CoV-2 (COVID-19). RESULTS: Fifteen patients (five from each arm of the trial) took part in a semi-structured interview. Thematic analysis identified three themes: day to day living, standard hospital care versus telemedicine management and living though COVID-19 with CPAP. CONCLUSIONS: All participants described significant symptoms caused by their OSA before diagnosis. While CPAP treatment was often described as challenging, patients discussed the improvement in their symptoms with treatment. There were differing opinions on virtual appointments, however the consensus was the use of telemedicine to support CPAP treatment was well received. COVID-19 appeared to have little effect on the patient experience.

Can the Use of Telemedicine in the Management of Continuous Positive Airway Pressure for the Treatment of Obstructive Sleep Apnea Reduce Clinical Time and Additional Appointments: A Randomized Controlled Trial.

Introduction: Obstructive sleep apnea (OSA) is a common sleep breathing disorder and is associated with increased cardiovascular risk and daytime sleepiness. Continuous positive airway pressure (CPAP) is a treatment for OSA, which splints the airway open. The introduction of telemedicine in CPAP devices offers clinical staff an alternative method of reviewing patients, monitoring treatment, and reducing clinical time. Materials and Methods: A randomized control trial was conducted with patients randomized to one of three arms: Arm 1 (standard care), Arm 2 (modem and a virtual appointment), and Arm 3 (modem, smart device application DreamMapper™, and a virtual appointment). Ninety participants requiring treatment with CPAP following a diagnosis of OSA were recruited and data collected at baseline, 14 days, and 180 days. Additional contacts or appointments were also recorded. Results: Ninety participants (n = 90) were recruited (68% males and 32% females) with an average age of 52.0 ± 13.13 years and apnea/hypopnea index (AHI) 43.5 ± 21.92 (events/h). There was a statistically significant difference between the three arms in the average clinical time taken for the first follow-up appointment (p = 0.001). There was a statistically significant difference between the three arms in the number of additional appointments or contacts required (p = 0.03). Discussion and Conclusion: Telemedicine reduced clinical time at first follow-up, and in patients who received standard care or a smart device application to monitor their own CPAP treatment, there were significantly less additional appointments required when compared with telemedicine support in the form of a modem alone.

The Use of Telemedicine in the Management of Continuous Positive Airway Pressure for the Treatment of Obstructive Sleep Apnoea: A Randomised Controlled Trial.

Introduction: Obstructive sleep apnea (OSA) is a condition whereby the airway gets partially or totally obstructed during sleep. Gold standard treatment for moderate to severe OSA is continuous positive airway pressure (CPAP). However, compliance with treatment is often poor, with low hours of usage and patients stopping treatment. Methods: A nonblinded, single-center, randomized controlled trial was conducted with patients randomized to 1 of 3 arms (arm 1, standard care; arm 2, modem; and arm 3, modem and DreamMapper™ app). Ninety patients diagnosed with OSA requiring CPAP were recruited. Data, including CPAP compliance, apnea/hypopnea index (AHI), and Epworth sleepiness score (ESS), were collected at baseline and 14 and 180 days post-CPAP initiation. Results: Of the group participants (N = 90), 68% were male and 32% female with a mean age of 52.0 ± 13.13 years, mean body-mass index of 36.4 ± 7.91 (kg/m2), mean ESS of 10.19 ± 5.75, and mean AHI of 43.5 ± 21.92 (events/hour). There was no statistically significant difference between the three arms in mean hours of CPAP usage in 24 hours at 14 days: arm 1, 6.22 ± 2.15; arm 2, 5.47 ± 2.25; and arm 3, 6.44 ± 1.54 (p = 0.256). There were also no statistically significant differences between the three arms in mean hours of CPAP usage in 24 hours at 180 days: arm 1, 6.20 ± 1.27; arm 2, 5.57 ± 1.49; and arm 3, 6.26 ± 1.29 (p = 0.479). Discussion and Conclusion: Compliance with CPAP treatment showed no significant differences between the three arms, with high compliance observed in all arms.