Telemedici ne Management of Veterans With Newly Diagnosed Obstructiv e Sleep Apnea (OSA)

Obstructive sleep apnea is a high-priority clinical condition for the Veterans Health Administration. With approximately 2% of middle-aged women and 4% of middle-aged men having OSA, the disorder places significant burden on the healthcare system. Obstructive sleep apnea (OSA) has been linked to major cardiovascular disorders such as coronary artery disease, congestive heart failure, hypertension, and stroke, as well as increased risk for motor vehicle crashes. Positive airway pressure (PAP) therapy is considered the treatment of choice for obstructive sleep apnea. However, adherence rates with CPAP and APAP therapy are disappointingly low. Veterans, especially those who are socioeconomically disadvantaged and those with psychiatric disease, demonstrate poor adherence when compared to the general population. Effective interventions are needed to improve adherence among patients diagnosed with OSA.

Currently, veterans diagnosed with OSA at the Philadelphia VA sleep center are treated with a home APAP machine that records their adherence on a smart card. They are scheduled for a follow-up appointment within one to three months after their initiation of APAP therapy to discuss questions and concerns regarding the machine as well as the mask and to download their adherence data. Given the limited availability of clinic appointments, some patients may have to wait longer than this.

More recently, APAP machines now distributed through the VA system offer the possibility of using wireless transmissions to track adherence data, including hours of use, mask leak, and apnea-hypopnea index (this transmission does not require hook up to the telephone and does not require the patient to have internet access). This offers the opportunity to see if remote monitoring within the first several weeks of APAP treatment improves adherence, and in turn, improves clinical response to treatment. At the present time, all patients enrolled at Philadelphia Veterans Administration Medical Center (PVAMC) who are newly diagnosed with OSA are being provided with APAP machines with modems that allow for wireless transmissions of data through the Phillips Respironics HIPPA compliant website, www.encoreanywhere.com. Review of the modem data is being performed on a limited basis in some patients. If remote monitoring improves adherence, the investigators may want to implement it for all APAP users. At present, the investigators do not know if this is a clinically effective or cost effective model for delivering health care.

The investigators will have a baseline chart review. It will include assessment of APAP settings (auto-titrate pressure ranges), model and size of mask interface, baseline sleep study results (mean AHI), and review of surveys now obtained as part of routine clinical care at the investigators sleep center, including: Epworth Sleepiness Scale (ESS) score, functional outcomes of sleep questionnaire (FOSQ) score, center for epidemiological studies of depression scale (CES-D score), short form health survey (SF-12), a health survey score and client satisfaction questionnaire (CSQ-8).

Sleep center staff will also perform a chart review to obtain demographic information (age, sex, race), BMI, daytime oxygen saturation (if available), and co-morbidities (congestive heart failure, diabetes, hypertension, obesity, chronic obstructive pulmonary disease (COPD), and depression or other psychological disorders) as part of their problem list in the computerized VA medical record. the investigators will use this chart review to compute a Charlson Morbidity Index.