CC BY-NC-ND 4.0 · Sleep Sci 2022; 15(01): 118-127
DOI: 10.5935/1984-0063.20210035
OVERVIEWS

Telemedicine in sleep-related breathing disorders and treatment with positive airway pressure devices. Learnings from SARS-CoV-2 pandemic times

Carlos Maria Franceschini
1   Hospital Cosme Argerich Gobierno de la Ciudad de Buenos Aires, Sleep and Mechanical Ventilation Unit, Intensive Therapy Division - Caba - Ciudad Autónoma de Buenos Aires - Argentina.
,
Marcela Viviana Smurra
2   Hospital Enrique Tornú. Gobierno de la Ciudad de Buenos Aires, Sleep and Respiratory Failure Laboratory, Pneumonology Service - Caba - Ciudad Autónoma de Buenos Aires - Argentina.
› Author Affiliations

ABSTRACT

The healthcare system currently faces new challenges, which are to be addressed by finding efficient alternatives. Such factors as the growth of world population, the increase in longevity, and the fact that some diseases which used to be deadly diseases have turned into chronic pathologies, cause the number of people in need for continuous medical care to rise. This results in a healthcare system crisis, which searches for solutions as telemedicine to address the needs of patients and control excessive medical spending. Telemedicine means remote medical assistance delivered by means of technological resources, which streamline the provision of medical care, thus increasing patient’s access to healthcare and saving time and costs. As regards respiratory diseases, telemedicine is a tool that may provide for proper prevention, diagnosis, therapeutic education, monitoring of observance, and therapeutic efficacy, as well as for the early detection of exacerbations. Patients suffering from sleep-related respiratory disorders in need for positive airway pressure devices may be benefited by telemedicine to enhance positive pressure adherence and follow-up to treat their pathologies, thus providing for the delivery of remote care and follow-up, reducing costs, and increasing the chances of receiving attention from specialists in patients who live a long distance from such medical facilities. However, it is a challenging task to find a balance in the doctor-patient virtual relationship.



Publication History

Received: 01 December 2020

Accepted: 31 May 2021

Article published online:
01 December 2023

© 2022. 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/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 
  • REFERENCES

  • 1 World Health Assembly (WHA). 71st Agenda Iiem 12.4 - Digital Health. Geneva: WHA; 2018.
  • 2 Pérez PN, Sánchez AJC, Gómez MCJ, Villegas PS, Garrido CSC, Martin NL. Analysis of the geographical distribution of specialized physicians in Argentina. PAHO/WHO; 2014.
  • 3 Sood S, Mbarika V, Jugoo S, Dookhy R, Doarn CR, Prakash N, Merrell RC. What is telemedicine? A collection of 104 peer-reviewed perspectives and theoretical underpinnings. Telemed E-Health. 2007 Oct;13(5):573-90. DOI: https://doi.org/10.1089/tmj.2006.0073
  • 4 Hellman J, Kruitwage ET, Van Den Berg LH, Visser-Meily JMA, Beelen A. The current use of telehealth in ALS care and the barriers to and facilitators of implementation: a systematic review. Amyotrophic Lateral Scler Frontotemporal Degener. 2020 May;21(3-4):167-82.
  • 5 Isetta V, Negrín MA, Moasterio C, Masa JF, Feu N, Álvarez A, et al. A Bayesian cost-effectiveness analysis of a telemedicine-based strategy for the management of sleep apnoea: a multicentre randomised controlled trial. Thorax. 2015 Nov;70(11):1054-61.
  • 6 Bruyneel M. Telemedicine in the diagnosis and treatment of sleep apnoea. Eur Respir Rev. 2019 Mar;28(151):180093.
  • 7 Franceschini CM, et al. Telemonitoring on CPAP adherence in patients with mild and severe obstructive sleep apnea. RAMR. 2019;(Suppl ):130-1.
  • 8 Borel JC, Pelletier J, Taleux N, Brinault A, Arnol N, Pison C, et al. Parameters recorded by software of non-invasive ventilators predict COPD exacerbation: a proof-of-concept study. Thorax. 2015 Mar;70(3):284-5.
  • 9 Mansell SK, Cutts S, Hackney I, Wood MJ, Kawksworth K, Creer DD, et al. Using domiciliary non-invasive ventilator data downloads to inform clinical decision-making to optimize ventilation delivery and patient compliance. BMJ Open Respir Res. 2018 Mar;5(1):e000238.
  • 10 Nogueira F, et al. User guides for the diagnosis and treatment of obstructive sleep apnea-hypopnea syndrome: 2019 revision - sleep, oxygen therapy, and chronic home therapies. RAMR. 2019;1:59-90.
  • 11 Yaggi HK, Concato J, Kernan WN, Lichtman JH, Brass LM, Mohsenin V. Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med. 2005 Nov;353(19):2034-41.
  • 12 Engleman HM, Martin SE, Douglas NJ. Compliance with CPAP therapy in patients with the sleep apnoea/hypopnoea syndrome. Thorax. 1994 Mar;49(3):263-6.
  • 13 Flemons WW, Douglas NJ, Kuna ST, Rodestein DO, Wheatley J. Access to diagnosis and treatment of patients with suspected sleep apnea. Am J Respir Crit Care Med. 2004 Mar;169(6):668-72.
  • 14 Borsini E, Blanco M, Bosio M, Fernando DT, Ernst G, Salvado A. “Diagnosis of sleep apnea in network” respiratory polygraphy as a decentralization strategy. Sleep Sci. 2016;9(3):244-8.
  • 15 Qaseem A, Dallas P, Owens DK, Starkey M, Holty JEC, Shekelle P, et al. Diagnosis of obstructive sleep apnea in adults: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2014 Aug;161(3):210-20.
  • 16 Gagnadoux F, Pelletier-Fleury N, Philippe C, Rakotonanahary D, Fleury B. Home unattended versus hospital telemonitored polysomnography in suspected obstructive sleep apnea syndrome: a randomized crossover trial. Chest. 2002 Mar;121(3):753-8.
  • 17 Han S, Kim J, Won SM, Ma Y, Kang D, Xie Z, et al. Battery-free, wireless sensors for full-body pressure and temperature mapping. Sci Transl Med. 2018 Apr;10(435):eaan4950.
  • 18 Alshaer H. New technologies for the diagnosis of sleep apnea. Curr Hypertens Rev. 2016;12(1):48-56.
  • 19 Coma-Del-Corral MJ, Alonso-Alvarez ML, Allende M, Cordero J, Ordax E, Masa F, et al. Reliability of telemedicine in the diagnosis and treatment of sleep apnea syndrome. Telemed J E Health. 2013 Jan;19(1):7-12.
  • 20 Penzel T, Schöbel C, Fietze I. New technology to assess sleep apnea: wireless, Smartphones and accessories. F1000Res 2018 Mar;7:413.
  • 21 Kribbs NB, Pack AI, Kline LR, Getsy JE, Schuett JS, Henry JN, et al. Effects of one night without nasal CPAP treatment on sleep and sleepiness in patients with obstructive sleep apnea. Am Rev Respir Dis. 1993 May;147(5):1162-8.
  • 22 Turino C, Batlle J, Woehrle H, Mayoral A, Castro-Grattoni AL, Gómez S, et al. Management of continuous positive airway pressure treatment compliance using telemonitoring in obstructive sleep apnoea. Eur Respir J. 2017 Feb;49(2):1601128.
  • 23 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 Nov;39:77-83.
  • 24 Munafo D, Hevener W, Crocker M, Willes L, Sridasome S, Muhsin M. A telehealth program for CPAP adherence reduces labor and yields similar adherence and efficacy when compared to standard of care. Sleep Breath. 2016 May;20(2):277-85.
  • 25 Suarez-Giron M, Garmendia O, Lugo V, Ruiz C, Salord N, Alsina X, et al. Mobile health application to support CPAP therapy in obstructive sleep apnoea: design, feasibility and perspectives. ERJ Open Res. 2020 Jan;6(1):2019-20.
  • 26 Bruyneel M, Van Den Broecke S, Libert W, Ninane V. Real-time attended home-polysomnography with telematic data transmission. Int J Med Inform. 2013;82(8):696-701.
  • 27 Pedone C, Chiurco D, Scarlata S, Incalzi RA. Efficacy of multiparametric telemonitoring on respiratory outcomes in elderly people with COPD: a randomized controlled trial. BMC Health Serv Res. 2013 Mar;13:82.
  • 28 Johnston N, Lambert K, Hassack P, Verdier MG, Higenbottam T, Lewis J, et al. Detection of COPD exacerbations and compliance with patient-reported daily symptom diaries using a smartphone-based information system. Chest. 2013 Aug;144(2):507-14.
  • 29 Halpin DMG, Laing-Morton T, Spedding S, Levy ML, Coyle P, Lewis J, et al. A randomised controlled trial of the effect of automated interactive calling combined with a health risk forecast on frequency and severity of exacerbations of COPD assessed clinically and using EXACT PRO. Prim Care Respir J. 2011 Sep;20(3):324-33.
  • 30 Borel JC, Pepin JL, Taleux N, Briault A, Arnol N, Pison C, et al. Parameters recorded by software of non-invasive ventilators predict COPD exacerbation: a proof-of-concept study. Thorax. 2015 Mar;70(3):284-5.
  • 31 Marina N, María ELS, Gáldiz JB. Telemedicine, an opportunity for spirometry. Arch Bronconeumol. 2018 Jun;54(6):306-7.
  • 32 Hansen H, Bieler T, Beyer N, Kallemose T, Wilcke JT, Ostergaard LM, et al. Supervised pulmonary tele-rehabilitation versus pulmonary rehabilitation in severe COPD: a randomised multicentre trial. Thorax. 2020 May;75(5):413-21.
  • 33 Paganoni S, Van de Rijn M, Drake K, Burke K, Doyle M, Elrrodt AS, et al. Adjusted cost analysis of video televisits for the care of people with amyatrophic lateral sclerosis. Muscle Nerve. 2019 Aug;60(2):147-54.
  • 34 Pinto A, Almeida JP, Pinto S, Pereira J, Oliveira AG, Carvalho M. Home telemonitoring of non-invasive ventilation decreases healthcare utilisation in a prospective controlled trial of patients with amyotrophic lateral sclerosis. J Neurol Neurosurg Psychiatr. 2010 Nov;81(11):1238-42.
  • 35 Fernández-Granero M, Sanchez-Morillo D, Leon-Jimenez A. Computerized analysis of telemonitored respiratory sounds for predicting acute exacerbations of COPD. Sensors. 2015 Oct;15(10):26978-96. DOI: https://doi.org/10.3390/s151026978
  • 36 Contal O, Combescure C, Pepin JL, Jolliet P, Janssens JP. Monitoring of noninvasive ventilation by built-in software of home bilevel ventilators. Chest. 2012 Jul;141(2):469-76.
  • 37 Álvarez RF, Rabec C, Cuadrado GR, Hernández JAC, Rodríguez P, Georges M, et al. Monitoring noninvasive ventilation in patients with obesity hypoventilation syndrome: comparison between ventilator built-in software and respiratory polygraphy. Respiration. 2017 Jun;93(3):162-9. DOI: https://doi.org/10.1159/000454954
  • 38 Janssens JP, Borel JC, Pépin JL, SomnoNIV Group. Nocturnal monitoring of home non-invasive ventilation: the contribution of simple tools such as pulse oximetry, capnography, built-in ventilator software and autonomic markers of sleep fragmentation. Thorax. 2011 May;66(5):438-45.
  • 39 García-Rodríguez JF. Bioética, salud pública y tecnología médica salud en Tabasco. Salud en Tabasco. 2004;10(2):243-8.
  • 40 World Health Organization (WHO). Maintaining essential health services: operational guidance for the COVID-19 context: interim guidance, 1 June 2020. Geneva: WHO; 2020.
  • 41 Singh J, Chair M, Badr S, Epstein L, Fields B, Hwang D, et al. Sleep telemedicine implementation guide. Darien: American Academy of Sleep Medicine (AASM); 2017.