Sleep Telemedicine Practices: Checkpoint List and Practical Considerations in the COVID-19 Era

Accuracy of positive airway pressure titration through telemonitoring of auto‐adjusting positive airway pressure device connected to a pulse oximetry in patients with obstructive sleep apnea

“…Berry et al 2 considered AHI ≤ 12/h, measured at the optimal pressure as an acceptable limit for home PAP titration whereas Rosen et al 9 considered a level of AHI < 10 acceptable. Koivumäki et al 16 in a home PAP titration study used an ODI cut‐off >10/h and lastly the American Thoracic Society suggested that a follow‐up sleep recording under PAP therapy is not required in patients with a clinical improvement and a device estimation of AHI < 10/h or between 10 and 20/h 17 …”

“…In general, there is a growing convergence of the literature in postponing and rescheduling all diagnostic and therapeutic procedures involving access to the sleep unit, in promoting home diagnosis and home autotitration, in particular in promoting the use of telemedicine as much as possible for the entire diagnosis and titration procedure of the CPAP and follow up of the OSA 7–9,21–24 …”

“…6 One of most important recommendations is to limit as much as possible of all forms of access of patients to sleep units by implementing telemedicine and the use of BIS remote-controlled (BISrc) data. [7][8][9] However, data on virtual sleep units are limited. 10,11 Thus we tried to further validate telemonitoring for home PAP titration under the guidance of BISrc data only by verifying whether the information on the severity control of the OSA assessed at the end of the home PAP titration from BISrc data was comparable with that provided by a contemporary nocturnal portable multichannel monitoring (PM) during PAP (PM-PAP) at home used as the reference method and by analyzing the clinical efficacy of a home PAP-titration procedure guided by BISrc data.…”

“…The COVID‐19 pandemic has profoundly impacted sleep medicine, resulting in a drastic and generalized reduction of all diagnoses, therapy, and follow‐up activities 6 . One of most important recommendations is to limit as much as possible of all forms of access of patients to sleep units by implementing telemedicine and the use of BIS remote‐controlled (BISrc) data 7–9 . However, data on virtual sleep units are limited 10,11 …”

To Wear or Not Wear the Mask: Decline in Positive Airway Pressure Usage in Children with Sleep Disordered Breathing During the COVID-19 Pandemic

“…From mid-March 2020, there has been an observed 80% decrease in office visits and 56-fold increase in virtual care visits. 18 The benefits of telemedicine including telediagnosis, teletherapy, telemonitoring and teleconsultation have reduced waiting times, transportation time, visit costs and lowered infections rates, [43][44][45][46][47][48] which may also better accomodate schedules of families while reducing the need to take time off work or arranging for childcare. However, the disadvantages of telemedicine includes the inability to perform most physical examinations or procedures, difficulty establishing new therapeutic relationships which are especially important for sustaining PAP use and reinforcing education around sleep hygiene issues particularly during adolescence, dealing with certain complex mental health issues, difficulty with interpreting body language and nonverbal clues, and lacking the full degree of comfort and support that can be provided in person as well as privacy and continuity of care concerns.…”