scholarly journals Assessment of Patient Journey Metrics for Users of a Digital Obstructive Sleep Apnea Program: Single-Arm Feasibility Pilot Study (Preprint)

2021 ◽  
Author(s):  
Shefali Kumar ◽  
Emma Rudie ◽  
Cynthia Dorsey ◽  
Amy Blase ◽  
Adam V Benjafield ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Pilot Study ◽  
The United States ◽  
Attrition Rate ◽  
Apnea Test ◽  
Patient Journey ◽  
Therapy Initiation ◽  
Obstructive Sleep

BACKGROUND Despite the importance of diagnosis and treatment, obstructive sleep apnea (OSA) remains a vastly underdiagnosed condition; this is partially due to current OSA identification methods and a complex and fragmented diagnostic pathway. OBJECTIVE This prospective, single-arm, multistate feasibility pilot study aimed to understand the journey in a nonreferred sample of participants through the fully remote OSA screening and diagnostic and treatment pathway, using the Primasun Sleep Apnea Program (formally, Verily Sleep Apnea Program). METHODS Participants were recruited online from North Carolina and Texas to participate in the study entirely virtually. Eligible participants were invited to schedule a video telemedicine appointment with a board-certified sleep physician who could order a home sleep apnea test (HSAT) to be delivered to the participant's home. The results were interpreted by the sleep physician and communicated to the participant during a second video telemedicine appointment. The participants who were diagnosed with OSA during the study and prescribed a positive airway pressure (PAP) device were instructed to download an app that provides educational and support-related content and access to personalized coaching support during the study’s 90-day PAP usage period. Surveys were deployed throughout the study to assess baseline characteristics, prior knowledge of sleep apnea, and satisfaction with the program. RESULTS For the 157 individuals who were ordered an HSAT, it took a mean of 7.4 (SD 2.6) days and median 7.1 days (IQR 2.0) to receive their HSAT after they completed their first televisit appointment. For the 114 individuals who were diagnosed with OSA, it took a mean of 13.9 (SD 9.6) days and median 11.7 days (IQR 10.1) from receiving their HSAT to being diagnosed with OSA during their follow-up televisit appointment. Overall, the mean and median time from the first televisit appointment to receiving an OSA diagnosis was 21.4 (SD 9.6) days and 18.9 days (IQR 9.2), respectively. For those who were prescribed PAP therapy, it took a mean of 8.1 (SD 9.3) days and median 6.0 days (IQR 4.0) from OSA diagnosis to PAP therapy initiation. CONCLUSIONS These results demonstrate the possibility of a highly efficient, patient-centered pathway for OSA workup and treatment. Such findings support pathways that could increase access to care, reduce loss to follow-up, and reduce health burden and overall cost. The program’s ability to efficiently diagnose patients who otherwise may have not been diagnosed with OSA is important, especially during a pandemic, as the United States shifted to remote care models and may sustain this direction. The potential economic and clinical impact of the program’s short and efficient journey time and low attrition rate should be further examined in future analyses. Future research also should examine how a fast and positive diagnosis experience impacts success rates for PAP therapy initiation and adherence. CLINICALTRIAL ClinicalTrials.gov NCT04599803; https://clinicaltrials.gov/ct2/show/NCT04599803

scholarly journals 0737 Diagnostic Value And Financial Effects Of Recertification Polysomnography In Medicare Patients With Obstructive Sleep Apnea

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A280-A281
Author(s):  
S E Neill ◽  
R Majid
Keyword(s):  
Health Care ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
The United States ◽  
Initial Study ◽  
Diagnostic Value ◽  
Obstructive Sleep ◽  
Medicare Patients ◽  
Care Costs

Abstract Introduction The annual cost of diagnosis and treatment of obstructive sleep apnea (OSA) exceeds 12.4 billion dollars in the United States. The Centers for Medicare and Medicaid Services (CMS) require that after initiation of positive airway pressure (PAP) therapy patients have physician follow up and comply with specific requirements. Otherwise, continued PAP benefits are terminated and patients must undergo repeat sleep testing to reinstate therapy. Repeat testing can become an economic burden. We hypothesize that restudying patients prior to reinstating PAP therapy does not change the diagnosis and may only result in increased health care costs. Methods A chart review of polysomnographic studies (PSG) was performed on Medicare referrals made for the purposes of recertification to the Memorial Hermann Sleep center between October 2018 and 2019. Demographic and diagnostic data (including AHI) were collected. The percentage of patients with a change of diagnosis between the initial study and the recertification study was documented. Results 429 Medicare patients were referred for polysomnography. 34 patients were referred for PAP recertification. The average age in the recertification group was 65 years, 47% were male with an average BMI of 33.4 kg/m2. The average AHI on the recertification study was 33.5 events/hour (range 7-114). None of the patients sent for PAP recertification by polysomnography had a negative study for OSA. Conclusion Repeat PSG did not change the need for PAP therapy in patients originally diagnosed with OSA (all the patients continued to qualify). The mandatory referral of all patients who do not meet the CMS requirements for continued benefits for PAP, represents an extra cost to the health care system without a change in the clinical therapy. This money may better be utilized in providing patient education known to improve adherence to PAP. Support N/A

scholarly journals 0951 A Pilot Study For In-patient Screening Of Stroke Patients For Obstructive Sleep Apnea In A Community Hospital, And To Assess Follow Up Of Suspected OSA

SLEEP ◽  
2019 ◽  
Vol 42 (Supplement_1) ◽  
pp. A382-A383
Author(s):  
Esther Fischer ◽  
Divya Gupta ◽  
Laura Suhan ◽  
Nurse Practictioner ◽  
Michele Siegel ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Pilot Study ◽  
Community Hospital ◽  
Stroke Patients ◽  
Patient Screening ◽  
Obstructive Sleep

scholarly journals Design and Evaluation of a Non-Contact Bed-Mounted Sensing Device for Automated In-Home Detection of Obstructive Sleep Apnea: A Pilot Study

Biosensors ◽  
2019 ◽  
Vol 9 (3) ◽  
pp. 90 ◽  
Author(s):  
Mosquera-Lopez ◽  
Leitschuh ◽  
Condon ◽  
Hagen ◽  
Rajhbeharrysingh ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Pilot Study ◽  
Pressure Sensors ◽  
Diagnostic System ◽  
High Sensitivity ◽  
Apnea Hypopnea Index ◽  
P Value ◽  
Apnea Test ◽  
Obstructive Sleep

We conducted a pilot study to evaluate the accuracy of a custom built non-contactpressure-sensitive device in diagnosing obstructive sleep apnea (OSA) severity as an alternative toin-laboratory polysomnography (PSG) and a Type 3 in-home sleep apnea test (HSAT). Fourteenpatients completed PSG sleep studies for one night with simultaneous recording from ourload-cell-based sensing device in the bed. Subjects subsequently installed pressure sensors in theirbed at home and recorded signals for up to four nights. Machine learning models were optimized toclassify sleep apnea severity using a standardized American Academy of Sleep Medicine (AASM)scoring of the gold standard studies as reference. On a per-night basis, our model reached a correctOSA detection rate of 82.9% (sensitivity = 88.9%, specificity = 76.5%), and OSA severity classificationaccuracy of 74.3% (61.5% and 81.8% correctly classified in-clinic and in-home tests, respectively).There was no difference in Apnea Hypopnea Index (AHI) estimation when subjects wore HSATsensors versus load cells (LCs) only (p-value = 0.62). Our in-home diagnostic system providesan unobtrusive method for detecting OSA with high sensitivity and may potentially be used forlong-term monitoring of breathing during sleep. Further research is needed to address the lowerspecificity resulting from using the highest AHI from repeated samples.

Improvement in Obstructive Sleep Apnea (OSA) in Super Morbidly Obese Patients After Bariatric Surgery

2020 ◽  
Vol 103 (8) ◽  
pp. 725-728
Keyword(s):  
Bariatric Surgery ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Lifestyle Modification ◽  
Apnea Hypopnea Index ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Obstructive Sleep ◽  
Objective Evidence

Background: Lifestyle modification is the mainstay therapy for obese patients with obstructive sleep apnea (OSA). However, most of these patients are unable to lose the necessary weight, and bariatric surgery (BS) has been proven to be an effective modality in selected cases. Objective: To provide objective evidence that BS can improve OSA severity. Materials and Methods: A prospective study was conducted in super morbidly obese patients (body mass index [BMI] greater than 40 kg/m² or BMI greater than 35 kg/m² with uncontrolled comorbidities) scheduled for BS. Polysomnography (PSG) was performed for preoperative assessment and OSA was treated accordingly. After successful surgery, patients were invited to perform follow-up PSG at 3, 6, and 12 months. Results: Twenty-four patients with a mean age of 35.0±14.0 years were enrolled. After a mean follow-up period of 7.8±3.4 months, the mean BMI, Epworth sleepiness scale (ESS), and apnea-hypopnea index (AHI) significantly decreased from 51.6±8.7 to 38.2±6.8 kg/m² (p<0.001), from 8.7±5.9 to 4.7±3.5 (p=0.003), and from 87.6±38.9 to 28.5±21.5 events/hour (p<0.001), respectively. Conclusion: BS was shown to dramatically improve clinical and sleep parameters in super morbidly obese patients. Keywords: Morbid obesity, Bariatric surgery, Obstructive sleep apnea (OSA)

4-Year Follow-up of Treatment With Dental Appliance or Uvulopalatopharyngoplasty in Patients With Obstructive Sleep Apnea

CHEST Journal ◽  
2002 ◽  
Vol 121 (3) ◽  
pp. 739-746 ◽  
Author(s):  
Marie-Louise Walker-Engström ◽  
Åke Tegelberg ◽  
Bo Wilhelmsson ◽  
Ivar Ringqvist
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Obstructive Sleep ◽  
Dental Appliance

scholarly journals Initiation of therapy for obstructive sleep apnea syndrome: a randomized comparison of outcomes of telemetry-supported home-based vs. sleep lab-based therapy initiation

2021 ◽  
Author(s):  
Ingo Fietze ◽  
Sebastian Herberger ◽  
Gina Wewer ◽  
Holger Woehrle ◽  
Katharina Lederer ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Control Group ◽  
Sleep Laboratory ◽  
Home Therapy ◽  
Home Management ◽  
Therapy Initiation ◽  
Home Based ◽  
Obstructive Sleep ◽  
At Home

Abstract Purpose Diagnosis and treatment of obstructive sleep apnea are traditionally performed in sleep laboratories with polysomnography (PSG) and are associated with significant waiting times for patients and high cost. We investigated if initiation of auto-titrating CPAP (APAP) treatment at home in patients with obstructive sleep apnea (OSA) and subsequent telemonitoring by a homecare provider would be non-inferior to in-lab management with diagnostic PSG, subsequent in-lab APAP initiation, and standard follow-up regarding compliance and disease-specific quality of life. Methods This randomized, open-label, single-center study was conducted in Germany. Screening occurred between December 2013 and November 2015. Eligible patients with moderate-to-severe OSA documented by polygraphy (PG) were randomized to home management or standard care. All patients were managed by certified sleep physicians. The home management group received APAP therapy at home, followed by telemonitoring. The control group received a diagnostic PSG, followed by therapy initiation in the sleep laboratory. The primary endpoint was therapy compliance, measured as average APAP usage after 6 months. Results The intention-to-treat population (ITT) included 224 patients (110 home therapy, 114 controls); the per-protocol population (PP) included 182 patients with 6-month device usage data (89 home therapy, 93 controls). In the PP analysis, mean APAP usage at 6 months was not different in the home therapy and control groups (4.38 ± 2.04 vs. 4.32 ± 2.28, p = 0.845). The pre-specified non-inferiority margin (NIM) of 0.3 h/day was not achieved (p = 0.130); statistical significance was achieved in a post hoc analysis when NIM was set at 0.5 h/day (p < 0.05). Time to APAP initiation was significantly shorter in the home therapy group (7.6 ± 7.2 vs. 46.1 ± 23.8 days; p < 0.0001). Conclusion Use of a home-based telemonitoring strategy for initiation of APAP in selected patients with OSA managed by sleep physicians is feasible, appears to be non-inferior to standard sleep laboratory procedures, and facilitates faster access to therapy.

scholarly journals The Worsening of Positional Mild Obstructive Sleep Apnea over Time Is Associated with an Increase in Body Weight: Impact on Blood Pressure and Autonomic Nervous System

Respiration ◽  
2021 ◽  
pp. 1-10
Author(s):  
Wei-Hsiu Chang ◽  
Hsien-Chang Wu ◽  
Chou-Chin Lan ◽  
Yao-Kuang Wu ◽  
Mei-Chen Yang
Keyword(s):  
Blood Pressure ◽  
Obstructive Sleep Apnea ◽  
Nervous System ◽  
Autonomic Nervous System ◽  
Sleep Apnea ◽  
Obstructive Sleep ◽  
Mild Obstructive Sleep Apnea ◽  
Positional Dependency ◽  
Over Time

<b><i>Background:</i></b> Most patients with mild obstructive sleep apnea (OSA) are positional dependent. Although mild OSA worsens over time, no study has assessed the natural course of positional mild OSA. <b><i>Objectives:</i></b> The aim of this study was to evaluate the natural course of positional mild OSA, its most valuable progression predictor, and its impact on blood pressure (BP) and the autonomic nervous system (ANS). <b><i>Methods:</i></b> This retrospective observational cohort study enrolled 86 patients with positional mild OSA and 26 patients with nonpositional mild OSA, with a follow-up duration of 32.0 ± 27.6 months and 37.6 ± 27.8 months, respectively. Polysomnographic variables, BP, and ANS functions were compared between groups at baseline and after follow-up. <b><i>Results:</i></b> In patients with positional mild OSA after follow-up, the apnea/hypopnea index (AHI) increased (9.1 ± 3.3/h vs. 22.0 ± 13.2/h, <i>p</i> = 0.000), as did the morning systolic BP (126.4 ± 13.3 mm Hg vs. 130.4 ± 15.9 mm Hg, <i>p</i> = 0.011), and the sympathetic activity (49.4 ± 12.3% vs. 55.3 ± 13.1%, <i>p</i> = 0.000), while the parasympathetic activity decreased (50.6 ± 12.3% vs. 44.7 ± 13.1%, <i>p</i> = 0.000). The body mass index changes were the most important factor associated with AHI changes among patients with positional mild OSA (Beta = 0.259, adjust <i>R</i><sup>2</sup> = 0.056, <i>p</i> = 0.016, 95% confidence interval 0.425 and 3.990). The positional dependency disappeared over time in 66.3% of patients with positional mild OSA while 69.2% of patients with nonpositional mild OSA retained nonpositional. <b><i>Conclusions:</i></b> In patients with positional mild OSA, disease severity, BP, and ANS regulation worse over time. Increased weight was the best predictor for its progression and the loss of positional dependency. Better treatments addressing weight control and consistent follow-up are needed for positional mild OSA.

Rapid maxillary expansion in children with obstructive sleep apnea syndrome: 12-month follow-up

2007 ◽  
Vol 8 (2) ◽  
pp. 128-134 ◽  
Author(s):  
Maria Pia Villa ◽  
Caterina Malagola ◽  
Jacopo Pagani ◽  
Marilisa Montesano ◽  
Alessandra Rizzoli ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Obstructive Sleep Apnea Syndrome ◽  
Sleep Apnea Syndrome ◽  
Rapid Maxillary Expansion ◽  
Maxillary Expansion ◽  
Obstructive Sleep ◽  
Apnea Syndrome
Sign in / Sign up

Export Citation Format

Share Document