Telemedicine in the diagnosis and treatment of sleep apnoea

TABLE 1

Terminology in telemedicine

Telemedicine	Distribution of healthcare by HCP using ICT technologies to exchange information useful to perform a distant diagnosis
Telediagnostic	Medical diagnosis made by means of telemedicine
Teleconsultation	Consultation between HCP or HCP and patients performed at a distance, via internet or video conferencing
Teletherapy	Remote initiation of a therapy
Telemonitoring	Wireless transmission of physiological or noninvasive data
Telematics	Use of ICT to allow computers to transfer data
Telecare	A combination of alarms, sensors and other equipment to help people live independently; in emergency situations the patients call for help
Telerehabilitation	Delivery of rehabilitation by HCP to patients at home via video conferencing
Telecoaching	Remote reinforcement to improve adherence
Telemetrics	Automatic measurement and transmission of data using ICT
Telexpertise	Enable a medical professional to solicit, remotely, the advice of medical professionals because of their particular expertise, for patient care

Note that this is a non-exhaustive list. HCP: healthcare providers; ICT: information and communication technologies.

TABLE 2

Potential use of telemedicine in obstructive sleep apnoea patient management

	Usual pathway	Telemedicine pathway
Diagnostic	Attended PSG and home PG	Remotely attended PSG/PG
Consultation	Face-to-face patient–physician consultation	Patient–physician teleconsultation
CPAP education	Face-to-face training	Video conferencing training
CPAP titration	Sleep lab attended CPAP titration and home APAP titration	Remotely attended CPAP titration
CPAP follow-up	Face-to-face patient–physician consultation	Telemonitoring, patient–physician teleconsultation, automated teledriven feedback, web-based supporting tools

CPAP: continuous positive airway pressure; APAP: automated CPAP; PSG: polysomnography; PG: polygraphy.

TABLE 3

Results of the randomised studies comparing telemedicine (TM) follow-up versus usual care for continuous positive airway pressure (CPAP) patients

First author [ref.]	Patients n	AHI events·h^-1	TM application	*Adherence TM versus* usual care**	Patient satisfaction
Stepnowsky [38]	45	>15	Interactive website with own CPAP data and guide for troubleshooting	2 months: 4.1 versus 3.4 h·night^-1 (statistically significant)	No concerns of being remotely observed
Fox [44]	75	>15; mean: 42	Feedback by phone	3 months: 3.2 versus 1.7 h·night^-1 (statistically significant)	NA
Isetta [45]	139	Mean: 49	Feedback by web tools	6 months: 4.4 versus 4.2 h·night^-1 (ns)	Similar degree satisfaction
Anttalainen [46]^#	111	Mean: 34	Nurse adjustment phone/visits	12 months: 6.4 versus 6.1 h·night^-1 (ns)	NA
Munafo [47]	132	Mean: 34 (TM), 27 (usual care)	Multimedia approach to contact patient about their CPAP use	1 month: 5.1 versus 4.7 h·night^-1 (ns)	Very good acceptance of the TM programme
Frasnelli [48]^¶	223	Median: 37 (TM), 40 (usual care)	Pneumologist adjustment by phone	1 month: 5.3 versus 4.6 h·night^-1 (statistically significant)	Overall satisfaction better in usual care group; privacy concerns
Hoet [49]	46	>20	Sleep technician adjustment phone/visits	3 months: 5.7 versus 4.2 h·night^-1 (statistically significant)	NA
Turino [50]	100	>15	Pneumologist adjustment by phone	3 months: 5.1 versus 4.9 h·night^-1 (ns)	Overall satisfaction better in usual care group; privacy concerns