COVID-19-related changes in outpatient CPAP setup pathways for OSA are linked with decreased 30-day CPAP usage

Turnbull, Chris D.; Allen, Martin; Appleby, Jennifer A; Brown, Richard S.; Bryan, Nathalie; Cooper, Ann; Cooper, Brendan; Gillooly, Cathie; Davidson, James; Farley, Hannah; Gaspar, Ana; Gibbons, Gillian; Gray, Beverley; Hill, Graham L.; Kendrick, Adrian; Marsh, Blake; McMillan, Alison; Page, Joseph; Pepperell, Justin; Quinnell, Timothy; Rogers, Chris; Sexton, Jane; Sheperd, Naomi; Steier, Joerg; Stockley, James; Stradling, John; Woroszyl, Asia; West, Sophie; Wright, Susan; Nickol, Annabel H.

doi:10.1136/thoraxjnl-2021-218635

Cited by 11 publications

(9 citation statements)

References 5 publications

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“…They found that pre-pandemic median CPAP usage was 5.4 (2.7-6.9) h per night at the first follow-up and this fell by 0.9 h per night (95% CI 0.5-1.2, p<0.0001) in 2020. The authors state that they found clinically relevant reductions in CPAP usage with the pathway changes introduced post-COVID-19 [23]. Similar findings are reported in a study which allocated 666 patients to three pathways for PAP treatment initiation [24].…”

Section: Mitigation Strategies To Overcome the Lockdown Of Sleep Medi...supporting

confidence: 68%

“…However, there is evidence from studies that a remote start for PAP treatment is associated with reduced long-term compliance. A multicentre study in the UK compared the adherence rate with PAP treatment when started at a distance during the pandemic with historic data from 2018 and 2019, when PAP treatment was started during a face-to-face meeting [23]. They found that pre-pandemic median CPAP usage was 5.4 (2.7-6.9) h per night at the first follow-up and this fell by 0.9 h per night (95% CI 0.5-1.2, p<0.0001) in 2020.…”

Section: Mitigation Strategies To Overcome the Lockdown Of Sleep Medi...mentioning

confidence: 99%

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Lessons for sleep medicine learned from the COVID-19 pandemic

Grote

2022

Breathe

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During the coronavirus disease 2019 (COVID-19) pandemic, sleep medicine services were dramatically reduced worldwide. Implementation of mitigation strategies was suggested by expert organisations and helped to restart sleep medicine services. Distance communication and monitoring during diagnosis, treatment initiation, and treatment follow-up have been used widely, in particular for patients with sleep apnoea. Follow-up studies demonstrate both advantages and potential disadvantages with the use of these new technologies.Emerging epidemiological evidence suggests that obstructive sleep apnoea may be an independent risk factor for adverse outcome in COVID-19, including an increased risk for hospitalisation and elevated mortality. Experimental studies explaining the underlying mechanisms behind these findings are warranted.

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Section: Mitigation Strategies To Overcome the Lockdown Of Sleep Medi...supporting

confidence: 68%

Section: Mitigation Strategies To Overcome the Lockdown Of Sleep Medi...mentioning

confidence: 99%

Lessons for sleep medicine learned from the COVID-19 pandemic

Grote

2022

Breathe

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“…This increase in CPAP usage is consistent with earlier meta-analyses which focused on the use of virtual care strategies specifically to investigate the effect on CPAP adherence [ 15 – 17 ]. However, recent post-COVID-19 data has shown a reduction in CPAP adherence with remote CPAP set-up, compared to in-person [ 11 , 35 ]. While CPAP set-up is just one part of the process of initiation onto therapy, these data highlight the need for robust assessment of new healthcare strategies before they become mainstream.…”

Section: Discussionmentioning

confidence: 99%

“…Accelerated by the coronavirus disease 2019 (COVID-19) pandemic [ 9 ], digital health interventions such as telemonitoring and virtual consultations have been introduced into sleep medicine to meet this growing demand [ 10 , 11 ]. Such transition has the potential to revolutionise the way healthcare is delivered, improving accessibility and affordability [ 12 ], though there are concerns about exacerbating inequalities, particularly in disadvantaged communities such as minorities and rural populations [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

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

Alsaif

Kelly²,

Little³

et al. 2022

Eur Respir Rev

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BackgroundThe 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 questionWhat 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?MethodsA 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.Results12 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.ConclusionThe 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.

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“…With the advent of the COVID-19 pandemic, according to a multicenter study, the F2F setup decreased drastically from 98.9% prepandemic to 1.1% during the pandemic. 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 ].…”

Section: Managementmentioning

confidence: 99%

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

Gunta

Jakulla

Ubaid

et al. 2022

Cardiovascular Therapeutics

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Obstructive sleep apnea (OSA) is one of the most common and serious sleep-related breathing disorders with a high prevalence among patients with cardiovascular (CV) diseases. Despite its widespread presence, OSA remains severely undiagnosed and untreated. CV mortality and morbidity are significantly increased in the presence of OSA as it is associated with an increased risk of resistant hypertension, heart failure, arrhythmias, and coronary artery disease. Evaluation and treatment of OSA should focus on recognizing patients at risk of developing OSA. The use of screening questionnaires should be routine, but a formal polysomnography sleep study is fundamental in establishing and classifying OSA. Recognition of OSA patients will allow for the institution of appropriate therapy that should alleviate OSA-related symptoms with the intent of decreasing adverse CV risk. In this review, we focus on the impact OSA has on CV disease and evaluate contemporary OSA treatments. Our goal is to heighten awareness among CV practitioners.

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COVID-19-related changes in outpatient CPAP setup pathways for OSA are linked with decreased 30-day CPAP usage

Cited by 11 publications

References 5 publications

Lessons for sleep medicine learned from the COVID-19 pandemic

Lessons for sleep medicine learned from the COVID-19 pandemic

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

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

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