Telemedicine in Sleep Medicine

Fayçal Abdenbi

LEARNING OBJECTIVES

On completion of this chapter, the reader should be able to:

1. Provide an overview of telemedicine applications in sleep medicine and the technologist’s role.
2. Describe how to use telemedicine to manage patients on positive airway pressure and other therapies.
3. Identify the major opportunities for and challenges to telemedicine implementation.
4. Describe the factors that make a program successful and less successful.
5. Design a viable model for telemedicine implementation where you work.

Sleep disorders, in general, and sleep-disordered breathing (SDB), more particularly, affect a substantial number of subjects and may be increasing in prevalence (1, 2), with a potentially serious health impact (3). Several studies have shown that daytime sleepiness is a risk factor for motor vehicle accidents (4) and may have significant socioprofessional consequences (5). The Sleep Heart Health Study has shown that in patients with excessive daytime sleepiness or difficulty initiating or maintaining sleep, health-related quality of life is impacted (6).

Although physicians understand the importance of sleep and its impact on a patient’s health, many sleep disorders remain unrecognized and untreated in clinical practice (7). Improving awareness of various types of sleep disorders and their impact on patients and public health can lead to a higher demand not only for documentation but also for diagnosis, treatment, and follow-up.

Many sleep disorders, particularly sleep apnea, are chronic conditions and require continuous treatment and monitoring of therapy success. However, barriers such as long distances between these services and the patients’ home or long waiting lists can prevent sufferers from getting quick or easy access to those medical services. In such cases, telemedicine and remote patient-physician interaction could be useful to establish diagnostic and therapeutic strategies and improve access to medical services.

Telemedicine is a bidirectional interaction between patients and health care providers (8), which consists of delivering remote health care services by using telecommunications technologies. In such a system, health care professionals can diagnose (telediagnostics), treat (teletherapy), and monitor (telemonitoring) the patients from a distance without the need of their physical presence, while the patients’ data are transmitted from one site to another via Internet or smartphones. We will review some of the applications of telemedicine in sleep medicine and the technologist’s role in it.

USE OF TELEMEDICINE FOR SLEEP DIAGNOSTICS

In the context of a highly prevalent disease such as SDB (2) having a significant impact on health, sleep laboratories are facing an increased demand for sleep testing with scarcity of sleep specialists. Such factors can keep the sleep laboratories busy and overloaded with a prolonged waiting list of patients requiring a screening and diagnosis. This has triggered more usage of portable equipment for home sleep apnea testing (HSAT), which is becoming more accurate, more sensitive, and more specific in detecting respiratory events.

With a HSAT setup, the patient will perform the sleep recording at home by applying the sensors to himself or herself at bedtime following the sleep technologist’s instructions, which are usually provided at the time of the consultation. When the patient returns the equipment to the sleep center, the sleep technologist will perform a data download from the device and score
the study. The right therapeutic decision will then highly rely on the accuracy of the sleep technologist’s scoring.

Using telemedicine techniques could help extend diagnostic services to wide sectors of the population (9). Coma-del-Corral et al. (10) have examined the technical feasibility of performing respiratory polysomnography (PSG) along with real-time transmission of sleep sounds and images of the patients to their sleep unit (80 km distance) in a group of 40 subjects with a clinical suspicion of obstructive sleep apnea (OSA) syndrome. At the sleep unit, the technologists were continuously monitoring in real time the recording and the patient images transmitted. They have observed good agreement between the data transmitted in real time and that stored in the polygraph. This virtual sleep unit extends the possibilities of providing specialized health care to a geographically distant population and can lead to reducing the patient’s travel time and expense as well as optimizing the sleep center’s resources.

In a prospective study, Borsini et al. (11) have explored the feasibility of establishing a network of satellite units for the diagnosis of sleep disorders connected to a reference Central Sleep Unit using respiratory PSG with remote data transmission. Of 499 studies, only 20 recordings (4%) were invalid because of cannula or oximeter disconnection. The study concluded that remote diagnosis strategy using portable respiratory PSG was useful in diagnosing OSA patients with a low probability of missing data and with safe transmission from remote centers to the Central Sleep Unit.

Only gold members can continue reading. Log In or Register to continue