CC BY-NC-ND 4.0 · Sleep Sci 2021; 14(S 01): 31-40
DOI: 10.5935/1984-0063.20200086
ORIGINAL ARTICLE

Proposed management model for the use of telemonitoring of adherence to positive airway pressure equipment - position paper of the Brazilian Association of Sleep Medicine - ABMS

Tatiana de Aguiar Vidigal
1   Universidade Federal de São Paulo (UNIFESP), Departamento de Psicobiologia - São Paulo - São Paulo - Brazil.
2   Universidade Federal de São Paulo (Unifesp), Dep. de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço - São Paulo - São Paulo - Brazil.
,
Evelyn Lucien Brasil
3   Hospital Israelita Albert Einstein, Dep. de pacientes graves e Terapia PAP -São Paulo - São Paulo - Brazil.
,
Morgana Nicolodelli Ferreira
4   Hipnos Assessoria e Produtos para o Sono, Adaptação e monitoramento Terapia PAP - Curitiba - Paraná - Brazil.
,
Luciane Luna Mello-Fujita
1   Universidade Federal de São Paulo (UNIFESP), Departamento de Psicobiologia - São Paulo - São Paulo - Brazil.
,
Gustavo Antonio Moreira
1   Universidade Federal de São Paulo (UNIFESP), Departamento de Psicobiologia - São Paulo - São Paulo - Brazil.
5   Universidade Federal de São Paulo (UNIFESP) Departamento de Pediatria -São Paulo - São Paulo - Brazil.
,
Luciano F. Drager
6   Sleep Laboratory, Pulmonary Division, Heart Institute (InCor), Hospital das Clinicas HCFMUSP, Universidade de São Paulo - São Paulo - São Paulo - Brazil.
,
Leticia Azevedo Soster
6   Sleep Laboratory, Pulmonary Division, Heart Institute (InCor), Hospital das Clinicas HCFMUSP, Universidade de São Paulo - São Paulo - São Paulo - Brazil.
,
Pedro Rodrigues Genta
6   Sleep Laboratory, Pulmonary Division, Heart Institute (InCor), Hospital das Clinicas HCFMUSP, Universidade de São Paulo - São Paulo - São Paulo - Brazil.
,
Dalva Poyares
1   Universidade Federal de São Paulo (UNIFESP), Departamento de Psicobiologia - São Paulo - São Paulo - Brazil.
,
Fernanda Louise Martinho Haddad
1   Universidade Federal de São Paulo (UNIFESP), Departamento de Psicobiologia - São Paulo - São Paulo - Brazil.
2   Universidade Federal de São Paulo (Unifesp), Dep. de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço - São Paulo - São Paulo - Brazil.
› Institutsangaben

ABSTRACT

This document “Proposed management model for the use of telemonitoring to positive airway pressure adherence” was prepared by a special commission of the Brazilian Association of Sleep Medicine, with the objective of recommending a follow-up model for patients undergoing positive airway pressure therapy using telemonitoring. This proposal was prepared based on a survey and analysis of the most up-to-date national and international literature and uses the best available evidence to facilitate the standardization of care by Sleep Science specialists with potential benefit for patients. Among the conclusions of the document, it is emphasized that telemonitoring is an important tool that allows health professionals trained in sleep-disordered breathing to remotely monitor PAP therapy, allowing prompt and, when necessary, daily adjustments to be made in order to increase adherence to treatment. The authors also conclude that the privacy of the data received and shared during the provision of telemonitoring must be respected by the physician or health professional trained in sleep, with the authorization of the patient and/or person responsible, who should be made aware of the short-, medium- and long-term provision of the service.



Publikationsverlauf

Eingereicht: 10. August 2020

Angenommen: 09. Dezember 2020

Artikel online veröffentlicht:
30. November 2023

© 2023. Brazilian Sleep Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 
  • REFERENCES

  • 1 Martins AB, Tufik S, Moura SMGPT. Physiopathology of obstructive sleep apnea hypopneasyndrome. J Bras Pneumol. 2007 Jan/Feb;33(1):93-100.
  • 2 Gottlieb DJ, Punjabi NM. Diagnosis and management of obstructive sleep apnea: a review JAMA. 2020;323(14):1389-400. DOI: https://doi.org/10.1001/jama.2020.3514
  • 3 Tufik S, Santos-Silva R, Taddei JA, Bittencourt LRA. Obstructive sleep apnea syndrome in the Sao Paulo Epidemiologic Sleep Study. Sleep Med. 2010 May;11(5):441-6.
  • 4 Benjafield AV, Ayas NT, Eastwood PR, Heinzer R, Ip MSM, Morrell MJ, et al. Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis. Lancet Respir Med. 2019 Aug;7(8):687-98.
  • 5 Epstein LJ, Kristo D, Strollo Junior PJ, Friedman N, Malhotra A, Patil SP, et al. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. Adult Obstructive Sleep Apnea Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med 2009 Jun;5(3):263-76.
  • 6 Kapur VK, Auckley DH, Chowdhuri S, Kuhlmann DC, Mehra R, Ramar K, et al. Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2017 Mar;13(3):479-504.
  • 7 American Academy of Sleep Medicine (AASM). International classification of sleep disorders. 3rd ed. Darien, IL: AASM; 2014.
  • 8 Engleman H, Joffe D. Neuropsychological function in obstructive sleep apnoea. Sleep Med Rev. 1999 Mar;3(1):59-78.
  • 9 Marshall NS, Barnes M, Travier N, Campbell AJ, Pierce RJ, McEvoy RD, et al. Continuous positive airway pressure reduces daytime sleepiness in mild to moderate obstructive sleep apnoea: a meta-analysis. Thorax. 2006 May;61(5):430-4.
  • 10 Young T, Peppard P. Sleep-disordered breathing and cardiovascular disease: epidemiologic evidence for a relationship. Sleep 2000 Jun;23(4):S122-6.
  • 11 Terán-Santos J, Jiménez-Gómez A, Cordero-Guevara J. The association between sleep apnea and the risk of traffic accidents. Cooperative Group Burgos-Santander. N Engl J Med 1999 Mar;340(11):847-50.
  • 12 Malhotra RK, Kirsch DB, Kristo DA, Olson EJ, Aurora RN, Carden KA, et al. Polysomnography for obstructive sleep apnea should include arousal-based scoring: an American Academy of Sleep Medicine Position Statement. J Clin Sleep Med 2018 Jul;14(7):1245-7.
  • 13 Lévy P, Kohler M, McNicholas WT, Barbé F, McEvoy RD, Somers VK, et al. Obstructive sleep apnoea syndrome. Nat Rev Dis Primers. 2015 Jun;1:15015.
  • 14 Knauert M, Naik S, Gillespie MB, Kryger M. Clinical consequences and economic costs of untreated obstructive sleep apnea syndrome. World J Otorhinolaryngology Head Neck Surg. 2015 Sep;1(1):17-2.
  • 15 Garbarino S, Durando P , Guglielmi O, Dini G, Bersi F, Fornarino S, et al. Sleep apnea, sleep debt and daytime sleepiness are independently associated with road accidents. A cross-sectional study on truck drivers. PLoS One 2016 Nov;11(11):e0166262.
  • 16 Jurado-Gamez B, Guglielmi O, Gude F, Buela-Casal G. Workplace accidents, absenteeism and productivity in patients with sleep apnea Arch Bronconeumol 2015 May;51(5):213-8.
  • 17 Olaithe M, Bucks RS, Hillman DR, Eastwood PR. Cognitive deficits in obstructive sleep apnea: insights from a meta-review and comparison with deficits observed in COPD, insomnia, and sleep deprivation. Sleep Med Rev. 2016 Apr;38:39-49.
  • 18 Stranks EK, Crowe SF. The cognitive effects of obstructive sleep apnea: an updated meta-analysis. Arch Clin Neuropsychol. 2016 Mar;31(2):186-93.
  • 19 Iftikhar IH, Hoyos CM, Phillips CL, Magalang UJ, et al. Meta-analyses of the association of sleep apnea with insulin resistance, and the effects of CPAP on HOMA-IR, adiponectin, and visceral adipose fat. J Clin Sleep Med. 2015 Apr;11(4):475-85.
  • 20 Campos-Rodriguez F, Martinez-Garcia MA, de la Cruz-Moron I, Almeida-Gonzalez C, Catalan-Serra P, Montserrat JM. Cardiovascular mortality in women with obstructive sleep apnea with or without continuous positive airway pressure treatment: a cohort study Ann Intern Med. 2012 Jan;156(2):115-22.
  • 21 Yaggi HK, Concato J, Kernan WN, Lichtman JH, Brass LM, Mohsenin V. Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med. 2005 Nov;353(19):2034-41.
  • 22 Marin JM, Carrizo SJ, Vicente E, Agusti AGN. Long-ter m cardiovascular outcomes in men with obstructive sleep apnoea–hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet. 2005 Mar;365(9464):1046-53.
  • 23 Bradley TD, Floras JS. Obstructive sleep apnoea and its cardiovascular consequences. Lancet 2009 Jan;373(9657):82-93.
  • 24 Martínez-García MA, Campos-Rodríguez F, Catalán-Serra P, Soler-Cataluña JJ, Almeida-Gonzalez C, De la Cruz Morón I, et al. Cardiovascular mortality in obstructive sleep apnea in the elderly: role of long-term continuous positive airway pressure treatment: a prospective observational study. Am J Respir Crit Care Med 2012 Aug;186(9):909-16.
  • 25 Sawyer AM, Gooneratne NS, Marcus CL, Ofer D, Richards KC, Weaver TE. A systematic review of CPAP adherence across age groups: clinical and empiric insights for developing CPAP adherence interventions Sleep Med Rev. 2011 Dec;15(6):343-56.
  • 26 Javaheri S, Barbe F, Campos-Rodriguez F, Dempsey JA, Khayat R, Javaheri S, et al. Sleep apnea: types, mechanisms, and clinical cardiovascular consequences. J Am Coll Cardiol. 2017 Feb;69(7):841-58.
  • 27 Antic NA, Heeley E, Anderson CS, et al. The Sleep Apnea cardioVascular Endpoints (SAVE) trial: rationale, ethics, design, and progress Sleep. 2015 Aug;38(8):1247-57.
  • 28 Haddad F, Bittencourt L. Diagnóstico e tratamento da síndrome da apneia obstrutiva do sono (SAOS): guia prático. São Paulo: Livraria Médica Paulista Editora; 2008.
  • 29 Gallego C W, Dibur E, Salomone C, Di Bartolo CG. Compliance with continuous positive airway pressure therapy in patients with sleep apnea/hypopnea syndrome. Medicina B Aires. 2004;64(5):395-9.
  • 30 Bakker JP, Weaver TE, Parthasarathy S, Aloia MS. Adherence to CPA: what should we be aiming for, and how can we get there?. Chest. 2019;155(6):1272-87.
  • 31 Weaver TE, Maislin G, Dinges DF, Bloxham T, George CF, Greenberg H, et al. Relationship between hours of CPAP use and achieving normal levels of sleepiness and daily functioning. Sleep. 2007 Jun;30(6):711-9.
  • 32 Mickelson SA. Nasal surgery for obstructive sleep apnea syndrome. Otolaryngol. Clin N Am. 2016 Dec;49(6):1373-81. DOI: https://doi. org/10.1016/j.otc.2016.07.002
  • 33 Senn O, Brack T, Matthews F, Russi E W, Bloch KE. Randomized short-term trial of two auto CPAP devices versus fixed continuous positive airway pressure for the treatment of sleep apnea. Am J Respir Crit Care Med. 2003 Dec;168(12):1506-11.
  • 34 Rowland S, Aiyappan V, Hennessy C, Catcheside P, Chai-Coezer CL, McEvoy RD, et al. Comparing the efficacy, mask leak, patient adherence, and patient preference of three different CPAP interfaces to treat moderate-severe obstructive sleep apnea. J Clin Sleep Med. 2018 Jan;14(1):101-8.
  • 35 Lebret M, Rotty MC, Argento C, Pepin JL, Tamisier R, Arbib F, et al. Comparison of auto- and fixed-continuous positive airway pressure on air leak in patients with obstructive sleep apnea: data from a randomized controlled trial. Can Respir J. 2019;2019:6310956.
  • 36 Campos-Rodriguez F, Peña-Grinãn N, Reyes-Nunez N, De la Cruz-Moron I, Perez-Ronchel J, De la Vega-Gallardo F, et al. Mortality in obstructive sleep apnea–hypopnea patients treated with positive airway pressure. Chest. 2005 Aug;128(2):624-33.
  • 37 Barbé F, Durán-Cantolla J, Capote F, de la Peña M, Chiner E, Masa JF, et al. Long-term effect of continuous positive airway pressure in hypertensive patients with sleep apnea. Am J Respir Crit Care Med. 2010 Apr;181(7):718-26.
  • 38 Gentina T, Gentina E, Lamblin C, Jouniaux F, Codron F, Tulaimat A. Does CPAP use in the first 15 days predict its use after 4 months? A prospective French cohort study. J Sleep Disord Ther. 2015;5(1):1000222.
  • 39 Bouloukaki I, Giannadaki K, Mermigkis C, Tzanakis N, Mauroudi E, Moniaki V, et al. Intensive versus standard follow-up to improve continuous positive airway pressure compliance. Eur Respir J. 2014 Nov;44(5):1262-74.
  • 40 Weaver TE, Grunstein RR. Adherence to continuous positive airway pressure therapy: the challenge to effective treatment. Proc Am Thorac Soc. 2008 Feb;5(2):173-8.
  • 41 Patil SP, Ayappa IA, Caples SM, Kimoff RJ, Patel SR, Harrod CG. Treatment of adult obstructive sleep apnea with positive airway pressure: an American Academy of Sleep Medicine clinical practice guideline J Clin Sleep Med. 2019 Feb;15(2):335-43.
  • 42 Wallace DM, Shafazand S, Aloia MS, Wohlgemuth WK. The association of age, insomnia, and self-efficacy with continuous positive airway pressure adherence in black, white, and Hispanic U.S. veterans. J Clin Sleep Med. 2013 Sep;9(9):885-95.
  • 43 Kelly JM, Strecker RE, Bianchi MT. Recent developments in home sleep-monitoring devices. ISRN Neurol. 2012;2012:768794.
  • 44 Singh J, Badr MS, Diebert W, Epstein L, Hwang D, Karres V, et al. American Academy of Sleep Medicine (AASM) position paper for the use of telemedicine for the diagnosis and treatment of sleep disorders. J Clin Sleep Med. 2015 Oct;11(10):1187-98.
  • 45 Hoet F, Libert WC, Sanida, Van Den Broecke S, Bruyneel AV, Bruyneel M. Sleep. Telemonitoring in continuous positive airway pressure-treated patients improves delay to first intervention and early compliance: a randomized trial. Sleep Med. 2017 Nov;39:77-83.
  • 46 Bruyneel M. Telemedicine in the diagnosis and treatment of sleep apnoea. Eur Respir Rev. 2019 Mar;28(151):180093.
  • 47 Turino C, Batlle J, Woehrle H, Mayoral A, Castro-Grattoni AL, Gómez S, et al. Management of continuous positive airway pressure treatment compliance using telemonitoring in obstructive sleep apnoea. Eur Respir J. 2017;49(2):1601128.
  • 48 Fox N, Hirsch-Allen AJ, Goodfellow E, Wenner J, Fleetham J, Ryan CF, et al. The impact of a telemedicine monitoring system on positive airway pressure adherence in patients with obstructive sleep apnea: a randomized controlled trial. Sleep. 2012 Apr;35(4):477-81.
  • 49 Chang J, Derose S, Benjafield A, Crocker M, Kim J, Becker K, et al. Acceptance and impact of telemedicine in patient sub-groups with obstructive sleep apnea: analysis from the tele-OSA randomized clinical trial. Sleep 2017;40(Suppl 1):A201-A2.
  • 50 Hwang D, Chang J W, Benjafield AV, Crocker ME, Kelly C, Becker KA, et al. Effect of telemedicine education and telemonitoring on continuous positive airway pressure adherence. The tele-OSA randomized trial Am J Respir Crit Care Med. 2018 Jan;197(1):117-26.
  • 51 Chen C, Wang J, Pang L, Wang Y, Ma G, Liao W. Telemonitor care helps CPAP compliance in patients with obstructive sleep apnea: a systemic review and meta-analysis of randomized controlled trials Ther Adv Chronic Dis. 2020 Mar;11:1-11.
  • 52 Morgenthaler T, Alessi C, Friedman L, Owens J, Kapur V, Boehlecke B, et al. Practice parameters for the use of actigraphy in the assessment of sleep and sleep disorders: an update for 2007 Sleep. 2007 Apr;30(4):519-29
  • 53 Rueda AD, Santos-Silva R, Togeiro SM, Tufik S, Bittencourt LRA. Improving CPAP compliance by a basic educational program with nurse support for obstructive sleep apnea syndrome patients. Sleep Sci. 2009;2(1):8-13.
  • 54 Pelosi LB, Silveira MLC, Eckeli AL, Chayamiti EMPC, Almeida LA, Sander HH, et al. The importance of clinical monitoring for compliance with continuous positive airway pressure Braz J Otorhinolaryngol 2017 Jul/Ago;83(4):439-44.
  • 55 Drager LF, Malhotra A, Yan Y, Pépin JL, Armitstead JP, Woehrle H, et al. Adherence with positive airway pressure therapy for obstructive sleep apnea in developing versus developed countries: a big data study. J Clin Sleep Med. 2020 Nov 18; [Epub ahead of print]. DOI: https:// doi.org/10.5664/jcsm.9008
  • 56 Pépin JL, Tamisier R, Hwang D, Mereddy S, Parthasarathy S Does remote monitoring change OSA management and CPAP adherence? Respirology 2017 Nov;22(8):1508-17.
  • 57 Lugo V, Villanueva JA, Garmendia O, Montserrat JM. The role of telemedicine in obstructive sleep apnea management Exp Rev Respir Med 2017 Sep;11(9):699-709.
  • 58 Taylor Y, Eliasson A, Andrada T, Kristo D, Howard R. The role of telemedicine in CPAP compliance for patients with obstructive sleep apnea syndrome Sleep Breath 2006 Sep;10(3):132-8.
  • 59 Schwab RJ, Badr SM, Epstein LJ, Gay PC, Gozal D, Kohler M, et al. American Thoracic Society Documents – An Official American Thoracic Society Statement: continuous positive airway pressure adherence tracking systems. The optimal monitoring strategies and outcome measures in adults. Am J Respir Crit Care Med. 2013 Sep;188(5):613-20.
  • 60 Andrade RGS, Madeiro F, Piccin VS, Moriya HT, Schorr F, Sardinha PS, et al. Impact of acute changes in CPAP flow route in sleep apnea treatment. Chest. 2016 Dec;150(6):1194-201.
  • 61 Teo M, Amis T, Lee S, Falland K, Lambert S, Wheatley J. Equivalence of nasal and oronasal masks during initial CPAP titration for obstructive sleep apnea syndrome. Sleep. 2011 Jul;34(7):951-5.
  • 62 Smith I, Lasserson TJ. Pressure modification for improving usage of continuous positive airway pressure machines in adults with obstructive sleep apnoea. Cochrane Database Syst Rev. 2009 Oct;(4):CD003531.
  • 63 Kushida CA, Chediak A, Berry RB, Brown LK, Gozal D, Iber C, et al. Clinical guidelines for the manual titration of positive airway pressure in patients with obstructive sleep apnea. J Clin Sleep Med. 2008 Apr;4(2):157-71.
  • 64 Ayas NT, Patel SR, Malhotra A, Schulzer M, Malhotra M, Jung D, et al. Auto-titrating versus standard continuous positive airway pressure for the treatment of obstructive sleep apnea: results of a meta-analysis. Sleep. 2004 Mar;27(2):249-53.
  • 65 Haddad F, Bittencourt L. Recomendações para diagnóstico e tratamento da síndrome da apneia obstrutiva do sono no adulto. São Paulo: Estação Brasil; 2013.
  • 66 Nilius G, Franke KJ, Domanski U, Schroeder M, Ruhle KH. Effect of APAP and heated humidification with a heated breathing tube on adherence, quality of life, and nasopharyngeal complaints. Sleep Breath 2015 May;20(1):43-9.
  • 67 Weaver TE, Grunstein RR. Adherence to continuous positive airway pressure therapy: the challenge to effective treatment. Proc Am Thorac Soc. 2008 FEb;5(2):173-8.
  • 68 Ayres CM, Lohia S, Nguyen SA, Gillespie, MB. The effect of upper airway surgery on continuous positive airway pressure levels and adherence: a systematic review and meta-analysis. ORL J Otorhinolaryngol Relat Spec. 2016;78(3):119-25.
  • 69 Zonato AI, Martinho FL, Bittencourt LR, Gregório LC, Tufik S. Upper airway surgery: the effect on nasal continuous positive airway pressure titration on obstructive sleep apnea patients. Eur Arch Otorhinolaryngol. 2006 May;263(5):481-6.
  • 70 Chandrashekariah R, Shaman Z, Auckley D. Impact of upper airway surgery on CPAP compliance in difficult-to-manage obstructive sleep apnea. Arch Otolaryngol Head Neck Surg. 2008 Oct;134(9):926-30.
  • 71 Lettieri CJ, Shah AA, Holley AB, Kelly WF, Chang AS, Roop SA, et al. Effects of a short course of eszopiclone on continuous positive airway pressure adherence: a randomized trial. Ann Intern Med. 2009 Nov;151(10):696-702.
  • 72 Park JG, Olson EJ, Morgenthaler TI. Impact of zaleplon on continuous positive airway pressure therapy compliance J Clin Sleep Med. 2013 May;9(5):439-44. DOI: https://doi.org/10.5664/jcsm.2660
  • 73 Bradshaw DA, Ruff GA, Murphy DP. An oral hypnotic medication does not improve continuous positive airway pressure compliance in men with obstructive sleep apnea. Chest. 2006 Nov;130(5):1369-76
  • 74 Askland K, Wright L, Wozniak DR, Emmanuel T, Caston J, Smith I. Educational, supportive and behavioural interventions to improve usage of continuous positive airway pressure machines in adults with obstructive sleep apnoea. Cochrane Database Syst Rev. 2020;4(4):CD007736.