Introduction Non-invasive positive airway pressure therapy (NIPAPT), including bi-level and continuous airway pressure (CPAP), is used to treat children with multiple conditions including obstructive sleep apnea–hypopnea syndrome (OSAHS). Sustained improvement requires significant effort from the patient, their family and the clinical team. Increasingly, we have found that, despite inpatient establishment, adherence reduces and symptoms re-occur. Re-establishment requires further clinic reviews and admissions, often over several nights. In response, we undertook a pilot study in which 4G-modem equipped ventilators were used to enable remote monitoring of adherence in patients admitted for establishment/re-establishment of NIPAPT.
Methods From July 2019 all new/re-establishment patients requiring NIPAPT were offered and consented for remote monitoring. The secure monitoring system Airview© (Resmed) was used with the ventilator devices - Lumis 100 & 150 (Bi-Level) and Airsense S10 Elite (CPAP). Data collected included ventilator usage, AHI, leak and pressures. Data checks were carried out after one week of being established, and then regular intervals (up to 90 days). Retrospective adherence data was collected from patients prior to remote monitoring.
Results Post establishment, initial data (3 patients) showed variable overnight adherence with mean use 38 minutes, 47 minutes and 7 hours 26 minutes respectively. Following the first phone contact with the parents, a personalized plan was agreed and arranged. The aim of each plan addressed issues such as adjusting/changing the mask interface, humidification and parental encouragement. Further scheduled contacts will occur on a personalized basis. Parents will receive a satisfaction questionnaire at the end of the monitoring period.
Discussion Remote monitoring technology has the potential to guide adjustments in NIPAPT therapy, monitor and improve adherence and reduce financial burden of hospital based review. Our preliminary work shows high uptake. We await results of the patient satisfaction questionnaire and cost breakdown following pilot study completion.
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