“Diagnosis of sleep apnea in network” respiratory polygraphy as a decentralization strategy

Abstract

IntroductionObstructive sleep apnea syndrome (OSA) is diagnosed through polysomnography (PSG) or respiratory polygraphy (RP). Self-administered home-based RP using devices with data transmission could facilitate diagnosis in distant populations. The purpose of this work was to describe a telemedicine initiative using RP in four satellite outpatient care clinics (OCC) of Buenos Aires Hospital Británico Central (HBC).Materials and methodsOCC technicians were trained both in the use of RP. Raw signals were sent to HBC via intranet software for scoring and final report.ResultsDuring a 24-month 499 RP were performed in 499 patients: 303 men (60.7%) with the following characteristics (mean and standard deviation): valid time for manual analysis: 392.8 min (±100.1), AHI: 17.05 (±16.49 and percentile 25–75 [Pt]: 5–23) ev/hour, ODI (criterion 3%): 18.05 (±16.48 and Pt 25–75: 6–25) ev/hour, and time below 90% (T<90): 17.9% (±23.4 and Pt 25–75: 1–23). The distribution of diagnoses (absolute value and percentage) was: normal (66/13%), snoring (70/14%), mild (167/33.5%), moderate (110/22%), and severe (86/17.2%). Continuous positive airway pressure (CPAP) was indicated for 191 patients (38.6%). Twenty recordings (4%) were considered invalid and the RP had to be repeated.PSG at HBC was indicated in 60 (12.1%) cases (mild OSA or normal AHI with high ESS or cardiovascular disease).ConclusionsPhysicians were able to diagnosis OSA by doing portable respiratory polygraphy at distance. The remote diagnosis strategy presented short delays, safe data transmission, and low rate of missing data.

Telemedicine in the diagnosis and treatment of sleep apnoea

“…The first is to make home polygraphy recordings quickly available for analysis, using TM for data transmission. This has been studied by BORSINI et al [19] in Buenos Aires where polygraphy was performed at home, but fitted by non-expert technicians. Raw data were sent by e-mail the following day.…”

“…In this classical population of patients highly likely to suffer from OSA the failure rate was 4%, and 12% needed an additional in-lab PSG. These positive results have allowed healthcare providers to enhance accessibility to sleep tests in a large country with few expert sleep centres [19].…”

Acute response to 7-day therapy with CPAP in patients with moderate to severe obstructive sleep apnea and cardiac arrhytmia

“…Ours patients with OSA referred for CPAP showed proper adherence to treatment (6.6 hours per night), though they were not previously adapted before the training program on mask selection and other basic information delivered during the first week of therapy.We have to highlight that our population have high BMI 23 .…”

Posicionamiento de la Sociedad Española de Neumología y Cirugía Torácica en el uso de la telemedicina en los trastornos respiratorios del sueño y ventilación mecánica

“…En la tabla 3 se muestran los procedimientos clásicos en el manejo de los pacientes y los que ya se están incorporando. Los procedimientos diagnósticos en domicilio transferidos por Internet son factibles [43][44][45][46][47] y se considera que pueden evitar estudios hospitalarios más caros e incluso menos reales, pues el sujeto no está en su entorno habitual.…”