Abstract
Introduction
During the first surge of the COVID-19 pandemic in New York City, as New Yorkers were enjoined by authorities to stay-at-home, patient encounters were transitioned from office visits to telemedicine consultations. It was thought that increased stress during the pandemic would worsen rates of insomnia, and concerns regarding use of positive airway pressure (PAP) therapy during a respiratory pandemic would affect compliance. We sought to describe telemedicine success rates, the distribution of sleep problems evaluated remotely by telemedicine, and PAP compliance in our patient population.
Methods
Telemedicine encounters from March 16th through May 31st, 2020, were reviewed for show-rates, patient characteristics and clinician impressions, and were compared to administrative data from the 2.5 months prior to the stay-at-home period (the “control period”). PAP compliance was analyzed for forty randomly selected patients established on PAP therapy between January 1st and October 1st, 2019, and whose machines transmitted data to a digital management system between October 1st and December 31st, 2019. Compliance reports and AHI were compared between the stay-at-home- and control- periods for this randomly selected group of patients.
Results
The telemedicine show rate was 89.37% (compared to a 91.91% in-office show-rate during the control period); all these encounters were successfully completed. Sleep apnea was the predominant diagnosis during the stay-at-home period (44.33% of encounters), followed by insomnia (23.16%). Insomnia complaints were significantly higher during the stay-at-home period compared to the control period (23.16% versus 14.6% of encounters; p < .05), and among new- versus follow-up- patients (41.76% versus 35.99%). PAP compliance and AHI, however, were not statistically different for forty randomly selected patients between the control and stay-at-home periods.
Conclusion
Most stay-at-home period telemedicine encounters were successful. Sleep apnea, then insomnia, were common findings among new and follow-up patients during the stay-at-home period, and insomnia rates increased during the pandemic. PAP compliance and AHI were similar in a random cohort when compared between the stay-at-home and control periods.
Support (if any):
Patient characteristics and compliance with positive airway pressure therapy during New York City's 2020 COVID-19 pandemic stay-at-home orders: The NYU comprehensive epilepsy center-sleep center telemedicine experience
