Figures
- FIGURE 1
Study flow-chart. OSA: obstructive sleep apnoea; CPAP: continuous positive airway pressure; TC: telemedicine cohort; RC: retrospective cohort; APP: smartphone application; TC-noAPP: telemedicine cohort not using smartphone application; TC-APP: telemedicine cohort using smartphone application.
Tables
- TABLE 1
Patient characteristics
RC versus TC TC-noAPP versus TC-APP RC TC p-value TC-noAPP TC-APP p-value Patients 71 117 81 36 Males 48 (67.6%) 80 (68.4%) 1.000 57 (70.4%) 23 (63.9%) 0.631 Age, years 57.8±11.6 59.5±12.6 0.338 60.6±12.9 57.1±11.6 0.142 Smoking exposure 0.093 0.131 Never-smokers 25 (35.2%) 51 (43.6%) 34 (42.0%) 17 (47.2%) Smokers 17 (23.9%) 36 (30.8%) 22 (27.2%) 14 (38.9%) Former smokers 29 (40.8%) 30 (25.6%) 25 (30.9%) 5 (13.9%) BMI, kg·m−2 36.6±9.63 34.8±7.21 0.181 34.9±7.05 34.7±7.66 0.884 BMI category 0.250 0.239 Normal or healthy weight 2 (2.82%) 7 (5.98%) 3 (3.70%) 4 (11.1%) Overweight 18 (25.4%) 19 (16.2%) 15 (18.5%) 4 (11.1%) Obese 51 (71.8%) 91 (77.8%) 63 (77.8%) 28 (77.8%) Arterial hypertension 44 (62.0%) 67 (57.3%) 0.629 48 (59.3%) 19 (52.8%) 0.652 Diabetes mellitus 16 (22.5%) 25 (21.4%) 0.995 18 (22.2%) 7 (19.4%) 0.925 Dyslipidaemia 32 (45.1%) 45 (38.5%) 0.459 32 (39.5%) 13 (36.1%) 0.887 Gastro-oesophageal reflux disease 4 (5.63%) 2 (1.71%) 0.201 1 (1.23%) 1 (2.78%) 0.523 Kidney disease 5 (7.04%) 4 (3.42%) 0.302 3 (3.70%) 1 (2.78%) 1.000 Heart disease 18 (25.4%) 18 (15.4%) 0.136 13 (16.0%) 5 (13.9%) 0.983 Respiratory disease 0.033 1.000 COPD 5 (7.04%) 10 (8.55%) 7 (8.64%) 3 (8.33%) Asthma 6 (8.45%) 2 (1.71%) 2 (2.47%) 0 (0.00%) Interstitial lung disease 2 (2.82%) 0 (0.00%) 0 (0.00%) 0 (0.00%) Neurological disease 6 (8.45%) 9 (7.69%) 1.000 8 (9.88%) 1 (2.78%) 0.271 Hypothyroidism 4 (5.63%) 3 (2.56%) 0.429 1 (1.23%) 2 (5.56%) 0.224 Migraine 0 (0.00%) 4 (3.42%) 0.299 3 (3.70%) 1 (2.78%) 1.000 Fibromyalgia 1 (1.41%) 3 (2.56%) 1.000 2 (2.47%) 1 (2.78%) 1.000 Depression/anxiety 7 (9.86%) 17 (14.5%) 0.481 14 (17.3%) 3 (8.33%) 0.325 Malignant disease history 5 (7.04%) 2 (1.71%) 0.106 2 (2.47%) 0 (0.00%) 1.000 Educational level 0.175 0.465 Reading and writing difficulties or no high school 40 (58.0%) 78 (69.0%) 56 (71.8%) 22 (62.9%) High school and associated degree or college and graduate degree 29 (42.0%) 35 (31.0%) 22 (28.2%) 13 (37.1%) Data are presented as mean±sd unless otherwise stated. RC: retrospective cohort; TC: telemedicine cohort; TC-noAPP: telemedicine cohort not using smartphone application; TC-APP: telemedicine cohort using smartphone application; BMI: body mass index.
- TABLE 2
Obstructive sleep apnoea (OSA) diagnosis, continuous positive airway pressure (CPAP) treatment and follow-up
RC versus TC TC-noAPP versus TC-APP RC TC p-value TC-noAPP TC-APP p-value Patients 71 117 81 36 OSA diagnosis Diagnostic test 0.040 0.697 Nocturnal pulse oximetry 1 (1.41%) 8 (6.84%) 6 (7.41%) 2 (5.56%) Respiratory polygraphy 44 (62.0%) 83 (70.9%) 59 (72.8%) 24 (66.7%) Polysomnography 26 (36.6%) 26 (22.2%) 16 (19.8%) 10 (27.8%) AHI, events per h 46.0 (32.5–67.6) 40.8 (26.8–57.5) 0.134 36.8 (25.1–53.0) 53.1 (31.5–71.1) 0.022 In supine position 57.5 (39.2–72.4) 53.6 (32.0–70.2) 0.157 47.3 (28.9–66.3) 58.5 (38.6–75.6) 0.146 TST90 22.4±26.1% 19.0±22.1% 0.356 18.8±22.1% 19.4±22.4% 0.889 Sleepiness 0.292 0.019 No 7 (9.86%) 23 (20.0%) 12 (14.8%) 11 (32.4%) Passive 46 (64.8%) 62 (53.9%) 50 (61.7%) 12 (35.3%) Active 13 (18.3%) 21 (18.3%) 15 (18.5%) 6 (17.6%) Driving 5 (7.04%) 9 (7.83%) 4 (4.94%) 5 (14.7%) Apnoea <0.001 0.067 No 8 (11.3%) 6 (5.17%) 2 (2.47%) 4 (11.4%) Yes 50 (70.4%) 110 (94.8%) 79 (97.5%) 31 (88.6%) Does not know 13 (18.3%) 0 (0.00%) 0 (0.00%) 0 (0.00%) Fatigue <0.001 0.461 No 25 (35.2%) 10 (8.62%) 6 (7.41%) 4 (11.4%) Yes 46 (64.8%) 85 (73.3%) 58 (71.6%) 27 (77.1%) Does not know 0 (0.00%) 21 (18.1%) 17 (21.0%) 4 (11.4%) Restorative sleep 14 (19.7%) 29 (25.7%) 0.454 21 (25.9%) 8 (25.0%) 1.000 Choking 28 (40.0%) 50 (45.0%) 0.608 34 (42.5%) 16 (51.6%) 0.514 Nocturia, events per night 2.00 (1.00–3.00) 2.00 (1.00–3.00) 0.882 2.00 (0.00–3.00) 2.00 (1.00–3.00) 0.842 Epworth Sleepiness Scale score at diagnosis 11.2±5.45 10.7±5.26 0.531 10.9±5.27 10.1±5.28 0.444 CPAP treatment CPAP adaptation 64 (90.1%) 111 (94.9%) 0.346 75 (92.6%) 36 (100%) 0.222 Number of CPAP titrations required <0.001 1.000 1 56 (78.9%) 116 (99.1%) 80 (98.8%) 36 (100%) >1 15 (21.1%) 1 (0.85%) 1 (1.23%) 0 (0.00%) 95th percentile pressure, cmH2O 11.0±2.00 10.1±2.16 0.006 9.93±2.10 10.5±2.27 0.222 Residual AHI, events per h 1.60 (0.80–4.00) 4.00 (2.30–6.70) <0.001 4.10 (2.20–7.55) 3.40 (2.58–4.62) 0.424 Early follow-up# Follow-up visit attendance 58 (90.6%) 111 (100%) 0.004 75 (100%) 36 (100%) CPAP compliance, h·night−1 4.79±2.85 4.33±2.62 0.292 4.21±2.76 4.58±2.30 0.470 CPAP compliance >4 h·night−1 45 (70.3%) 70 (63.1%) 0.419 44 (58.7%) 26 (72.2%) 0.240 CPAP compliance >5 h·night−1 40 (56.3%) 56 (47.9%) 0.329 37 (45.7%) 19 (52.8%) 0.611 Epworth Sleepiness Scale score change after CPAP treatment 7.12±7.24 5.29±4.70 0.104 5.00±4.73 5.90±4.66 0.380 Patient satisfaction¶ 7.69±2.05 9.02±0.64 <0.001 9.00±0.64 9.06±0.64 0.665 Numbers in bold represent a p-value of <0.05. Data are presented as median (interquartile range) or mean±sd, unless otherwise stated. RC: retrospective cohort; TC: telemedicine cohort; TC-noAPP: telemedicine cohort not using smartphone application; TC-APP: telemedicine cohort using smartphone application; AHI: apnoea–hypopnoea index; TST90: total sleep time with oxygen saturation <90%. #: 1 month; ¶: score out of 10.
- TABLE 3
Multivariate models
Univariate Multivariate Odds ratio se 95% CI p-value Odds ratio se 95% CI p-value RC–TC multivariate logistic model: CPAP adherence >4 h per night Predictors (Intercept) 2.37 0.65 1.41–4.14 0.002 0.04 0.06 0.00–0.83 0.042 TC versus RC 0.72 0.24 0.37–1.38 0.331 0.64 0.24 0.30–1.33 0.239 Age 1.05 0.02 1.02–1.09 0.002 Sex (female) 1.21 0.47 0.58–2.62 0.614 BMI 1.02 0.02 0.97–1.07 0.517 Educational level# 1.80 0.70 0.85–3.94 0.134 AHI (events per h) 1.00 0.01 0.98–1.01 0.731 ESS at diagnosis 1.05 0.04 0.98–1.12 0.152 Observations 175 160 R2 Tjur 0.005 0.088 AIC 228.062 207.984 TC-noAPP–TC-APP multivariate logistic model: CPAP adherence >4 h per night Predictors (Intercept) 1.42 0.33 0.90–2.27 0.135 0.00 0.00 0.00–0.01 0.001 TC-APP versus TC-noAPP 1.83 0.81 0.79–4.49 0.169 2.09 1.12 0.75–6.23 0.169 Age 1.10 0.03 1.05–1.16 <0.001 Sex (female) 0.97 0.50 0.35–2.74 0.956 BMI 1.06 0.04 0.98–1.15 0.148 Educational level# 3.94 2.28 1.33–13.04 0.017 AHI (events per h) 1.02 0.01 1.00–1.04 0.132 ESS at diagnosis 1.05 0.05 0.96–1.15 0.289 Observations 111 100 R2 Tjur 0.017 0.216 AIC 148.248 125.753 Univariate Multivariate 1 Multivariate 2 Estimate se 95% CI p-value Estimate se 95% CI p-value Estimate se 95% CI p-value RC–TC multivariate linear model: patient satisfaction Predictors (Intercept) 7.69 0.17 7.35–8.02 <0.001 7.64 0.18 7.29–7.99 <0.001 7.63 0.22 7.19–8.07 <0.001 TC versus RC 1.33 0.21 0.91–1.75 <0.001 1.38 0.22 0.94–1.82 <0.001 1.40 0.23 0.94–1.85 <0.001 Age 0.04 0.11 −0.18–0.25 0.745 0.03 0.12 −0.20–0.26 0.794 BMI 0.10 0.11 −0.12–0.32 0.364 0.09 0.12 −0.15–0.32 0.463 AHI (events per h) −0.12 0.11 −0.33–0.09 0.242 −0.13 0.11 −0.34–0.09 0.248 ESS at diagnosis 0.24 0.11 0.02–0.45 0.030 0.24 0.11 0.02–0.45 0.029 Sex (female) 0.01 0.23 −0.45–0.47 0.967 Educational level# 0.02 0.24 −0.45–0.49 0.936 Observations 170 160 157 R2/R2 adjusted 0.190/0.185 0.227/0.202 0.232/0.196 AIC 582.165 553.937 157 Numbers in bold represent a p-value of <0.05. RC: retrospective cohort; TC: telemedicine cohort; CPAP: continuous positive airway pressure; BMI: body mass index; AHI: apnoea–hypopnoea index; ESS: Epworth Sleepiness Scale; AIC: Akaike information criterion; TC-noAPP: telemedicine cohort not using smartphone application; TC-APP: telemedicine cohort using smartphone application. #: high school and associated degree or college and graduate degree.
- TABLE 4
Patients’ survey on continuous positive airway pressure (CPAP) adaptation and follow-up
RC versus TC TC-noAPP versus TC-APP RC TC p-value TC-noAPP TC-APP p-value Patients 61 102 69 33 Satisfaction with the follow-up <0.001 0.103 No 9 (14.8%) 0 (0.00%) 0 (0.00%) 0 (0.00%) Partially 10 (16.4%) 2 (1.96%) 0 (0.00%) 2 (6.06%) Yes 42 (68.9%) 100 (98.0%) 69 (100%) 31 (93.9%) Easy access to healthcare professionals <0.001 No 12 (19.7%) 0 (0.00%) 0 (0.00%) 0 (0.00%) Partially 13 (21.3%) 0 (0.00%) 0 (0.00%) 0 (0.00%) Yes 36 (59.0%) 102 (100%) 69 (100%) 33 (100%) Confidence in the confidentiality of the data 0.018 No 1 (1.64%) 0 (0.00%) 0 (0.00%) 0 (0.00%) Partially 3 (4.92%) 0 (0.00%) 0 (0.00%) 0 (0.00%) Yes 57 (93.4%) 102 (100%) 69 (100%) 33 (100%) Rather be followed telematically or in person, i.e. the opposite group <0.001 1.000 No 25 (41.0%) 96 (94.1%) 65 (94.2%) 31 (93.9%) Partially 14 (23.0%) 0 (0.00%) 0 (0.00%) 0 (0.00%) Yes 22 (36.1%) 6 (5.88%) 4 (5.80%) 2 (6.06%) Increase in number of hours of CPAP because of the follow-up done 0.063 0.011 No 19 (31.1%) 50 (49.0%) 38 (55.1%) 12 (36.4%) Partially 15 (24.6%) 15 (14.7%) 5 (7.25%) 10 (30.3%) Yes 27 (44.3%) 37 (36.3%) 26 (37.7%) 11 (33.3%) Use of the telemedicine and telemonitoring system again or recommendation of it to others 0.390 No 0 (0%) 2 (1.96%) 1 (1.45%) 1 (3.03%) Partially 0 (0%) 2 (1.96%) 1 (1.45%) 1 (3.03%) Yes 0 (0%) 98 (96.1%) 67 (97.1%) 31 (93.9%) Numbers in bold represent a p-value of <0.05. RC: retrospective cohort; TC: telemedicine cohort; TC-noAPP: telemedicine cohort not using smartphone application; TC-APP: telemedicine cohort using smartphone application.
- TABLE 5
Application server data (telemedicine cohort with smartphone application (APP) use)
Patients 36 Messages sent No 14 (38.9%) Yes 22 (61.1%) Follow-up questionnaires No 11 (34.4%) Yes 21 (65.6%) Message initiation through the APP No messages 0 (0%) Patient 16 (72.7%) Sleep unit staff 6 (27.3%) Number of medical messages, median (interquartile range) 2.5 (1–5.75) Message subject Greeting 1 (4.6%) Adverse effect 15 (68.2%) General question CPAP 2 (9.1%) Question from the staff about an alert message 4 (18.2%) Messages resulted in action to improve CPAP adaptation No 12 (57.1%) Yes 9 (42.9%) Nasal congestion or obstruction when using CPAP No 7 (63.6%) Yes 3 (27.3%) Does not know 1 (9.1%) Air leaks with the use of CPAP No 9 (81.8%) Yes 2 (18.2%) Does not know 0 (0%) Skin marks or irritation with CPAP use No 7 (63.6%) Yes 4 (36.4%) Does not know 0 (0%) Dry mouth with CPAP use No 6 (54.6%) Yes 5 (45.5%) Does not know 0 (0%) Excessive air pressure with the use of CPAP No 8 (80%) Yes 2 (20%) Does not know 0 (0%) Chest or abdominal discomfort with CPAP use No 7 (70%) Yes 3 (30%) Does not know 0 (0%) Sleep time using CPAP, h, mean±sd 6.36±1.21 CPAP: continuous positive airway pressure.
Vol 8 Issue 4
Table of Contents
Telemedicine home CPAP titration and follow-up in the COVID-19 scenario
