Real-time attended home-polysomnography with telematic data transmission

https://doi.org/10.1016/j.ijmedinf.2013.02.008Get rights and content

Highlights

  • Real-time telemonitored HPSG is feasible.

  • It could be an interesting perspective to decrease the failure rate of home PSG.

  • As it is an innovatice device, we faced technical problems that we need to improve.

  • However, 90% of the recordings were of excellent quality.

Abstract

Purpose

Home-polysomnography (HPSG) has been proposed as a cost-effective alternative for obstructive sleep apnea (OSA) diagnosis.

We assessed, in a feasibility study, whether telematic transmission using the Dream® and Sleepbox® technologies was associated with low HPSG failure rate.

Methods

Patients referred by chest physicians for clinical suspicion of OSA underwent one HPSG, using Dream® and Sleepbox® (Medatec, Belgium), which is a wireless system able to communicate with Dream®, and with Internet through a wi-fi/3G interface. It is equipped with a digital infrared camera, and with a speaker/microphone system for bidirectional audio/video communication via Skype®.

The Sleep Lab nurse performed a remote discontinuous monitoring of the PSG. In case of sensor loss, she called the patient who had been previously educated to replace the sensors.

Results

Twenty-one patients have been studied. 90% of the recordings were of excellent quality. We observed a 10% PSG failure rate: one failure of the Dream®, and one recording of poor quality. There were 2 successful Skype® interventions resulting in readjustment of the defective probes (nasal cannula and EEG). PSG signal visualization was possible in 90% of cases but Skype® connection was problematic in 19% of cases. However, patients could be reached by phone to solve the problem.

Conclusions

Real-time attended HPSG through telematic data transmission is feasible and could be an interesting perspective to decrease the failure rate of home sleep studies, even if some technical aspects need to be improved.

Introduction

The use of assistive technology and telemedicine is likely to increase in developed countries [1], mainly to enhance monitoring in nursing homes, in hospital wards, and to allow data transmission from the patient's home, but also to face the increasing demand for medical investigations related with the aging of the population, the growing complexity of medical technology or to avoid patients displacement, especially when patients live far away from the hospital [2], [3].

Obstructive sleep apnea syndrome (OSA) is a growing health problem, which is now recognized as an independent risk factor for hypertension, coronary heart disease, stroke and motor vehicle accidents [4], [5], [6], [7]. The Wisconsin Sleep Cohort Study [8] found that OSA affected 2% of women and 4% of men but its prevalence, nowadays, is probably higher [9]. There is an increasing need for sleep study recordings and, despite the development of sleep medicine and sleep labs, the availability of polysomnography (PSG) remains limited in many countries [10] that face very long waiting lists.

Home sleep studies with portable monitoring (PM) devices have been proposed to decrease costs and facilitate the diagnostic process [11].

We have recently shown that home-PSG (Type 2 PM [12]) is a cost-effective alternative for the diagnosis of OSA, with a good diagnostic accuracy. It is more comfortable for the patients, whose sleep efficiency is better than in the hospital [13].

Others studies, performed with simplified portable devices, have also shown an interest in these methods for screening/diagnosis with variable results [11].

The major problem encountered with these devices is the potential loss of data, observed with polysomnographic procedures (4.7–20%) [13] as well as with polygraphic procedures (up to 24%) [14], leading to less cost-savings than expected.

The purpose of the study was to assess, in a feasibility study, whether telematic transmission using Dream® (portable polysomnographic device) and Sleepbox® technologies, with possible remote intervention, decreases home-PSG failure rate.

Section snippets

Patients

Twenty-one consecutive patients referred by chest physicians to our sleep laboratory for clinical suspicion of OSA have been studied.

Exclusion criteria included age under 18, restrictive respiratory disorders, other suspected sleep disorders and distance home-hospital >30 km.

They all accepted that a video system would be functioning in their own sleep room and that they could be contacted directly to solve potential problems related to recording, and had to sign written informed consent. The

Results

Between January and February 2012, 21 patients were recorded. No patient refused home recording. Characteristics of the patients are resumed in Table 3.

In all patients, 3G network quality was optimal.

The nurses were able to communicate with all patients at bedtime (100% successful SleepWeb and Skype® checks). They performed a total of 164 visualizations of the PSG via the Medatec SleepWeb program (mean of 8 checks/patient).

Sixteen times (9.75% of checks), the connection could not be established

Discussion

The main finding of this feasibility study is the demonstration that remote discontinuous attended home-PSG through telematic data transmission is feasible and could be an interesting perspective to decrease the failure rate of home sleep studies. To the best of our knowledge, this is also the first study using a real-time surveillance to enhance the quality of complete home sleep studies.

Ninety percent of the home-PSG has been graded as very good or excellent. Only one PSG had to be repeated,

Authors’ contribution

Marie Bruyneel and Vincent Ninane wrote the scientific project. Marie Bruyneel and Sandra Van den Broecke collected and analyzed the data. Walter Libert collected the data. All the authors participated to manuscript redaction.

Conflict of interest

None declared.

Summary points

What was already known on the topic:

  • Home-polysomnography (HPSG) is useful for OSA diagnosis but the failure rate of the recordings remains problematic.

  • When the quality of the recordings is bad, it leads to less cost-savings than expected.

  • Unattended polysomnography is better than polygraphy because it allows a wide range of diagnosis in sleep disorders.

What this study added to our knowledge:

  • Real-time telemonitored HPSG is feasible.

  • It could be an interesting

Acknowledgements

We thank warmly Mr Driessens, Mr Karmoun and all the staff of MEDATEC Company, Brussels, Belgium, for their precious and enthusiastic collaboration.

We also thank l’ “Association André Vésale-Aide à la recherche médicale” for their financial backing.

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