title: Telemedicine-based approach for obstructive sleep apnea management: building evidence.
abstract: BACKGROUND
  Telemedicine seems to offer reliable solutions to health care challenges, but significant contradictory results were recently found. Therefore, it is crucial to carefully select outcomes and target patients who may take advantage of this technology. Continuous positive airway pressure (CPAP) therapy compliance is essential to treat patients with obstructive sleep apnea (OSA). We believe that OSA patients could benefit greatly from a telemedicine approach for CPAP therapy management.
  
  
  OBJECTIVE
  The objective of our study was to evaluate the application of a telemedicine-based approach in the CPAP therapy management, focusing on patients' CPAP follow-up and training.
  
  
  METHODS
  We performed two studies. First, (study 1) we enrolled 50 consecutive OSA patients who came to our sleep center for the CPAP follow-up visit. Patients performed a teleconsultation with a physician, and once finalized, they were asked to answer anonymously to a questionnaire regarding their opinion about the teleconsultation. In a second randomized controlled trial (RCT) (study 2), we included 40 OSA patients scheduled for CPAP training. There were 20 that received the usual face-to-face training and 20 that received the training via videoconference. After the session, they were blindly evaluated on what they learned about OSA and mask placement.
  
  
  RESULTS
  More than 95% (49/50) of the interviewed patients were satisfied with the teleconsultation, and 66% (33/50) of them answered that the teleconsultation could replace 50%-100% of their CPAP follow-up visits. Regarding the RCT, patients who received the CPAP training via videoconference demonstrated the same knowledge about OSA and CPAP therapy as the face-to-face group (mean 93.6% of correct answers vs mean 92.1%; P=.935). Performance on practical skills (mask and headgear placement, leaks avoidance) was also similar between the two groups.
  
  
  CONCLUSIONS
  OSA patients gave a positive feedback about the use of teleconsultation for CPAP follow-up, and the CPAP training based on a telemedicine approach proved to be as effective as face-to-face training. These results support the use of this telemedicine-based approach as a valuable strategy for patients' CPAP training and clinical follow-up.
authors.affiliation: Unit of Biophysics and Bioengineering, Faculty of Medicine, University of Barcelona, Barcelona, Spain. valentina.isetta@ub.edu.
authors.forename: Valentina
authors.initials: V
authors.lastname: Isetta
authors.forename: Carmen
authors.initials: C
authors.lastname: León
authors.forename: Marta
authors.initials: M
authors.lastname: Torres
authors.forename: Cristina
authors.initials: C
authors.lastname: Embid
authors.forename: Josep
authors.initials: J
authors.lastname: Roca
authors.forename: Daniel
authors.initials: D
authors.lastname: Navajas
authors.forename: Ramon
authors.initials: R
authors.lastname: Farré
authors.forename: Josep M
authors.initials: JM
authors.lastname: Montserrat
keywords: CPAP therapy; sleep apnea; teleconsultation; telemedicine