Sleep telemedicine lacks immunity to Continuous Positive Airway Pressure device shortages

Abstract

In this issue of SLEEP, Kosky et al. [1] take a real-world approach to explore a particular application of sleep telemedicine. Their manuscript, “Telemedicine compared to standard face-to-face care for CPAP treatment: real-world Australian experience,” shows that the former is both feasible and noninferior to the latter in terms of CPAP adherence, efficacy, and sleepiness/functional outcome improvement. While the standard care arm participants reported slightly higher satisfaction than the telemedicine arm participants, there were significant cost savings in the telemedicine arm. The study is particularly notable for several reasons, including its pragmatic design. Participants were not randomized into standard- and telemedicine-based care, a common paradigm among similar trials. Individuals living more than 100 km from the sleep center became the telemedicine arm as they likely would in usual clinical practice. As Table 1 of the article demonstrates, demographic imbalances introduced by such a recruitment model were relatively minor. Another notable feature in the study’s design was its emphasis on CPAP treatment follow-up as opposed to initial evaluation or testing. That is, initial evaluations were not constrained to video consultation if the participant chose to have that initial visit face to face in Perth. Furthermore, all participants—standard and telemedicine arm—underwent in-laboratory sleep testing and face-to-face CPAP set-up (if indicated) at the same Perth sleep center. It was at this point that the treatment models diverged most consistently; telemedicine arm participants received CPAP follow-up via telephone and remote telemonitoring via built-in CPAP device modem, while standard arm participants received CPAP follow-up via face-to-face visits and physical device downloads. The results, summarized above, revealed that the technologic blend of video teleconferencing, telephone, and remote CPAP device downloading had delivered clinically rigorous, well-accepted, and cost-effective care. Participant enrollment concluded in June 2019, just as sleep telemedicine was about to face significant disruption.