A Fully Remote Diagnostic and Treatment Pathway in Patients with Obstructive Sleep Apnoea during the COVID-19 Pandemic: A Single Centre Experience

Abstract

The COVID-19 pandemic led to significant delays in the diagnostic and management pathway of patients with obstructive sleep apnoea (OSA). During the first wave of COVID-19, our department adopted a fully remote diagnostic (home cardiorespiratory polygraphy) and treatment (autoset continuous positive airway pressure, CPAP) approach. As a novel mode of service delivery, our aim was to evaluate our pathway and analyse factors associated with adherence to CPAP. We analysed the first 300 patients (51 ± 13 years, 48% men) who were set up on remote CPAP between 20 May 2020 and 11 September 2020. The associations between CPAP usage at 90 days and age, gender, body mass index, disease severity, Epworth Sleepiness Scale and comorbidities were investigated with linear and logistic regression analyses. A total of 124 patients (41.3%) were fully-adherent to CPAP therapy, defined as CPAP usage ≥ 4 h on ≥ 70% of the days. Only driving status was associated with adherence to CPAP. Patients who were adherent at 28 days were more likely to stay adherent at 90 days (3.77 odd ratio /3.10–4.45/ 95% confidence interval). We have shown that a fully remote diagnostic and treatment pathway for patients with OSA can be successfully delivered, and our preliminary outcomes of adherence to CPAP are comparable with published data.

Obstructive Sleep Apnea and Cardiovascular Diseases: Sad Realities and Untold Truths regarding Care of Patients in 2022

“…The study shows a significant drop in CPAP adherence as well [ 86 ]. However, one single-center study shows successful implementation of remote diagnostic and treatment pathways for CPAP with similar adherence patterns to the F2F setup pathways [ 87 ].…”

En Route to Personalised Medicine in Obstructive Sleep Apnoea

“…The adherence to CPAP treatment in the largest RCTs was suboptimal [1,2]. In a reallife population in the United Kingdom, adherence to CPAP was most strongly associated with driving status, and it did not relate to disease severity or daytime sleepiness [20]. This could prompt a patient-centred approach to improving adherence.…”

Pilot study of positive airway pressure usage, patient journey and program engagement for users of a digital obstructive sleep apnea program

“…Positive airway pressure (PAP) therapy is recommended as the first-line therapy option for OSA patients (3). Despite the importance and proven efficacy of PAP therapy, overall PAP adherence remains suboptimal; PAP adherence may settle between 25% and 83% (4)(5)(6)(7)(8)(9)(10). Hwang and colleagues reported on a telemedicine program for referred clinical patients demonstrating a 90-day PAP adherence rate of 58% (6).…”