title: Remote Ambulatory Management of Veterans with Obstructive Sleep Apnea.
abstract: OBJECTIVE
  Despite significant medical sequelae of obstructive sleep apnea (OSA), the condition remains undiagnosed and untreated in many affected individuals. We explored the feasibility of a comprehensive, telemedicine-based OSA management pathway in a community-based Veteran cohort.
  
  
  METHODS
  This prospective, parallel-group randomized pilot study assessed feasibility of a telemedicine-based pathway for OSA evaluation and management in comparison to a more traditional, in-person care model. The study included 60 Veterans at the Philadelphia Veterans Affairs Medical Center and two affiliated community-based outpatient clinics. Telemedicine pathway feasibility, acceptability, and outcomes were assessed through a variety of quantitative (Functional Outcomes of Sleep Questionnaire, dropout rates, positive airway pressure [PAP] adherence rates, participant satisfaction ratings) and qualitative (verbal feedback) metrics.
  
  
  RESULTS
  There was no significant difference in functional outcome changes, patient satisfaction, dropout rates, or objectively measured PAP adherence between groups after 3 months of treatment. Telemedicine participants showed greater improvement in mental health scores, and their feedback was overwhelmingly positive.
  
  
  CONCLUSIONS
  Our pilot study suggests that telemedicine-based management of OSA patients is feasible in terms of patient functional outcomes and overall satisfaction with care. Future studies should include larger populations to further elucidate these findings while assessing provider- and patient-related cost effectiveness.
authors.affiliation: Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Emory University, Atlanta, GA.|Atlanta Veterans Affairs Medical Center, Decatur, GA.
authors.forename: Barry G
authors.initials: BG
authors.lastname: Fields
authors.affiliation: Philadelphia Veterans Affairs Medical Center, Philadelphia, PA.|Division of Sleep Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.|Center for Sleep and Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: Pratima Pathak
authors.initials: PP
authors.lastname: Behari
authors.affiliation: Philadelphia Veterans Affairs Medical Center, Philadelphia, PA.
authors.forename: Susan
authors.initials: S
authors.lastname: McCloskey
authors.affiliation: Philadelphia Veterans Affairs Medical Center, Philadelphia, PA.
authors.forename: Gala
authors.initials: G
authors.lastname: True
authors.affiliation: Philadelphia Veterans Affairs Medical Center, Philadelphia, PA.
authors.forename: Diane
authors.initials: D
authors.lastname: Richardson
authors.affiliation: Philadelphia Veterans Affairs Medical Center, Philadelphia, PA.|Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: Arwin
authors.initials: A
authors.lastname: Thomasson
authors.affiliation: Philadelphia Veterans Affairs Medical Center, Philadelphia, PA.|Independent Researcher, Philadelphia, PA.
authors.forename: Danijela
authors.initials: D
authors.lastname: Korom-Djakovic
authors.affiliation: Philadelphia Veterans Affairs Medical Center, Philadelphia, PA.
authors.forename: Keith
authors.initials: K
authors.lastname: Davies
authors.affiliation: Philadelphia Veterans Affairs Medical Center, Philadelphia, PA.|Division of Sleep Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.|Center for Sleep and Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: Samuel T
authors.initials: ST
authors.lastname: Kuna
mesh_terms: D045422:Continuous Positive Airway Pressure; D019468:Disease Management; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010352:Patient Dropouts; D017060:Patient Satisfaction; D015143:Philadelphia; D010865:Pilot Projects; D011446:Prospective Studies; D018401:Sample Size; D012890:Sleep; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000628:therapy*; D011795:Surveys and Questionnaires; D017216:Telemedicine; D016896:Treatment Outcome; D014728:Veterans / Q000523:psychology
keywords: auto-titrating positive airway pressure; home sleep testing; obstructive sleep apnea; telemedicine