Telemonitoring for Positive Airway Pressure (PAP) therapy might help to establish and maintain long-term therapy adherence and thus support the beneficial effects of PAP therapy on long-term outcomes.
Airway obstructions, airflow resistance by partial occlusion of the airways or central sleep-breathing disorders, where the respiratory effort is reduced or stops, cause a reduction in airflow and lead to arousals from sleep and disturbances in gas exchange during sleep. The negative consequences manifest in increases of blood pressure, higher workload for the heart and daytime sleepiness. PAP (positive airway pressure) treats sleep-related breathing disorders. It applies pressure to nose and mouth to keep the airway from collapsing and provides pressure support to assist the respiratory muscles. The efficacy of the therapy is measured with apnoea- and hypopnoea-indices that count the total number of apnoeic events at night. To ensure an efficacious and efficient therapy, pressures have to be adjusted correctly and the patient needs to use PAP regularly. Telemonitoring is information and communication technology to exchange sleep data and to provide clinical guidance over distances. There is no defined spectrum of technology. It can comprise phone calls, video support or interaction programs via the internet. Some studies point to advantages of telemonitoring in keeping compliance upright, increase usage hours and some also point to economic advantages. However, we do not have conclusive data from large trials with telemonitoring on the long-term that would show conclusive effects, be it from the side of a patient or from a cost and labour perspective of providers or the healthcare sector. Still, there are uncertainties regarding data safety, reimbursement or connectivity of different systems. No long-term data of PAP therapy under telemonitoring and its effect on compliance and therapy outcomes is available by now.
Study Type
OBSERVATIONAL
Enrollment
14,147
Patients will receive a prescription for PAP therapy in the course of their clinical Routine pathway and afterwards be asked to enrol in the registry. The will be asked if they are willing to use telemonitoring technology.
Schlaf- und Beatmungszentrum Blaubeuren
Blaubeuren Abbey, Baden-Wurttemberg, Germany
Ambulante Schlafmedizin Herold/Kaa
Fürth, Bavaria, Germany
Klinikum Nürnberg-Med Klinik 3
Nuremberg, Bavaria, Germany
Klinik für Schlafmedizin Düsseldorf Grand Arc
Düsseldorf, North Rhine-Westphalia, Germany
Usage Patterns of PAP therapy with telemonitoring, assessed by data continuously recorded by the device and transferred via telemonitoring
Usage Patterns are hours/night and nights/month that therapy has been used. Telemonitoring enables the physician to remotely supervise device usage. Usage will be assessed through data recordings of the device: Days of usage \>3hours; Days of usage \<3 hours; total recorded days; mean daily usage (minutes); total usage hours (h)
Time frame: 24 months
Sleep disorders, assessed by personally questioning the Patient at baseline and at 24 months follow-up
Sleep disorders are snoring, insomnia, hypersomnia, depression, restless legs syndrome as assessed by anamnesis.
Time frame: 24 months
Therapy efficacy, assessed through changes in AHI and HI comparing baseline with 24 months follow-up
Efficacy is measured through changes in Apnea-Hypopnea-Index AHI (numbers of apneas - reduction of airflow by \>90% for at least 10 seconds - and hypopneas - reduction of airflow by \>30% for at least 10 seconds with a 4% decrease of Oxygen Saturation - divided by hours of sleep), AI - apnea index (apneas per hour), HI hypopnea index (hypopneas per hour).
Time frame: 24 months
Quality of Life, assessed with the Functional Outcomes of Sleep Questionnaire (FOSQ) comparing the score at baseline with the 24 months follow-up
The Functional Outcomes of Sleep Questionnaire had been developed to comprehensively capture the impact of sleeping disorders in relevant daily activities as for instance general activity, vigilance, intimacy, fitness and social life.
Time frame: 24 months
Factors leading to therapy Termination, assessed by personally questioning a Patient or Consulting a physician at time of follow-up
Possible causes for therapy Termination are assessed: Lost-to-follow-up, no interest in therapy, changed physician, no therapy benefits, Hospital stay, death
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Ruhrlandklinik Essen
Essen, North Rhine-Westphalia, Germany
Zentrum für Schlafmedizin Dr. Warmuth
Berlin, Germany
Time frame: 24 months