Telehealthcare interventions in the management of obstructive sleep apnoea hypopnoea syndrome (OSAHS) in continuous positive airway pressure (CPAP) users - A systematic review

Aim: Telehealthcare potentially offers an option for remotely monitoring and reviewing people using CPAP therapy. We aimed to systematically review the evidence for the effectiveness of telehealthcare CPAP review verses face-to-face care. Methods: We systematically searched electronic databases plus manual journal searches for clinical trials of telehealthcare for reviewing CPAP users. Two researchers selected, quality appraised and extracted data. Outcomes of interest were adherence to CPAP, subjective sleep, patient/clinician satisfaction, and cost effectiveness. We undertook a narrative analysis because of heterogeneity of outcomes. Results: 5 trials (total 224 patients) met our inclusion criteria. The trials were small at moderate/high risk of bias; the largest randomised 114 patients. Adherence was measured as number of hours used/night (n=3) or proportion using u003e 4 hours/night (n=2). Telemonitoring (TM) improved adherence to CPAP compared to usual care (UC) in x/5 trials. No reported differences in Epworth Sleepiness score (n=2 trials). 4/5 trials reported similar levels of satisfaction with the clinical review. 2/2 trials reported significant cost reductions with TM compared to UC. Conclusion: A telehealthcare model of clinical review in CPAP shows promise as a cost effective and acceptable model of care, which improved adherence, but not subjective sleepiness. However the evidence is limited to 5 small, generally poor quality studies. Fully-powered, well designed studies are required to prove clinical and cost effectiveness of using available technologies to access specialist sleep services remotely.