Telemedizin in der Therapieeinleitung schlafbezogener Atmungsstrungen

Der derzeitige Standard in Deutschland ist, dass die PAP-Therapie im Schlaflabor unter polysomnographischer Überwachung eingeleitet wird. Anschließend werdennach ungefähr 6 Wochen eine ambulante klinische Kontrolle, eventuell zusätzlich mit einer ambulanten Polygraphie sowie weitere jährliche Kontrollen empfohlen (1). Des Weiteren gibt es die Möglichkeit, die PAP-Therapie durch Analyse der im Gerät gespeicherten Daten zu verfolgen und gegebenenfalls zu optimieren. Je nach Gerätehersteller werden im Therapiegerät verschiedene Therapiedaten gespeichert (Anwendungsdauer, Anwendungsmuster, residuelle Atmungsstörungen gesamt/differenziert, Leckagen, Befeuchteranwendung, Druckverlauf), wobei keine einheitliche Validierung für einige dieser Informationen vorliegt.

• Literatur

• 1 S3-Leitlinie Nicht erholsamer Schlaf/Schlafstörungen – Ka[amacron]pi[amacron]tel „Schlafbezogene Atmungsstörungen“. Somnologie 2017; 20 (Suppl. 02) 97-180.
• 2 Schoch OD, Baty F, Niedermann J, Rudiger JJ, Brutsche MH. Baseline predictors of adherence to positive airway pressure therapy for sleep apnea: a 10-year single-center observational cohort study. Respiration; international review of thoracic diseases 2014; 87: 121-128.
• 3 Weaver TE, Maislin G, Dinges DF. et al. Relationship between hours of CPAP use and achieving normal levels of sleepiness and daily functioning. Sleep 2007; 30: 711-719.
• 4 Rotenberg BW, Murariu D, Pang KP. Trends in CPAP adherence over twenty years of data collection: a flattened curve. Journal of otolaryngology – head & neck surgery = Le Journal d‘oto-rhino-laryngologie et de chirurgie cervico-faciale 2016; 45: 43.
• 5 Sparrow D, Aloia M, Demolles DA, Gottlieb DJ. A tele-medicine intervention to improve adherence to continuous positive airway pressure: a randomised controlled trial. Thorax 2010; 65: 1061-1066.
• 6 Fox N, Hirsch-Allen AJ, Goodfellow E. et al. The impact of a telemedicine monitoring system on positive airway pressure adherence in patients with obstructive sleep apnea: a randomized controlled trial. Sleep 2012; 35: 477-481.
• 7 Woehrle H, Ficker JH, Graml A. et al. Telemedicine-based proactive patient management during positive airway pressure therapy: Impact on therapy termination rate. Somnologie : Schlafforschung und Schlafmedizin = Somnology : sleep research and sleep medicine 2017; 21: 121-127.
• 8 Mendelson M, Vivodtzev I, Tamisier R. et al. CPAP treatment supported by telemedicine does not improve blood pressure in high cardiovascular risk OSA patients: a randomized, controlled trial. Sleep 2014; 37: 1863-1870.
• 9 Turino C, de Batlle J, Woehrle H. et al. Management of continuous positive airway pressure treatment compliance using telemonitoring in obstructive sleep apnoea. The European respiratory journal. 2017: 49.
• 10 Isetta V, Negrin MA, Monasterio C. et al. A Bayesian cost-effectiveness analysis of a telemedicine-based strategy for the management of sleep apnoea: a multicentre randomised controlled trial. Thorax 2015; 70: 1054-1061.
• 11 Anttalainen U, Melkko S, Hakko S, Laitinen T, Saaresranta T. Telemonitoring of CPAP therapy may save nursing time. Sleep & breathing = Schlaf & Atmung 2016; 20: 1209-1215.
• 12 Hoet F, Libert W, Sanida C, Van den Broecke S, Bruyneel AV, Bruyneel M. Telemonitoring in continuous positive airway pressure-treated patients improves delay to first intervention and early compliance: a randomized trial. Sleep medicine 2017; 39: 77-83.
• 13 Munafo D, Hevener W, Crocker M, Willes L, Sridasome S, Muhsin M. A telehealth program for CPAP adherence reduces labor and yields similar adherence and efficacy when compared to standard of care. Sleep & breathing = Schlaf & Atmung 2016; 20: 777-785.
• 14 Hwang D, Chang JW, Benjafield AV. et al. Effect of Tele-medicine Education and Telemonitoring on Continuous Positive Airway Pressure Adherence. The Tele-OSA Randomized Trial. American journal of respiratory and critical care medicine 2018; 197: 117-126.
• 15 Liu D, Armitstead J, Benjafield A. et al. Trajectories of Emergent Central Sleep Apnea During CPAP Therapy. Chest 2017; 152: 751-760.
• 16 Pepin JD, Woehrle H, Liu D. et al. Adherence to Positive Airway Therapy After Switching From CPAP to ASV: A Big Data Analysis. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine 2018; 14: 57-63.
• 17 Malhotra A, Crocker ME, Willes L, Kelly C, Lynch S, Benjafield AV. Patient Engagement Using New Technology to Improve Adherence to Positive Airway Pressure Therapy: A Retrospective Analysis. Chest 2018; 153: 843-850.
• 18 Woehrle H, Arzt M, Graml A. et al. Effect of a patient engagement tool on positive airway pressure adherence: analysis of a German healthcare provider database. Sleep medicine 2018; 41: 20-26.
• 19 Berry RB, Sriram P. Auto-adjusting positive airway pressure treatment for sleep apnea diagnosed by home sleep testing. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine 2014; 10: 1269-1275.
• 20 Corral J, Sanchez-Quiroga MA, Carmona-Bernal C. et al. Conventional Polysomnography Is Not Necessary for the Management of Most Patients with Suspected Obstructive Sleep Apnea. Noninferiority, Randomized Controlled Trial. American journal of respiratory and critical care medicine 2017; 196: 1181-1190.
• 21 Lederer K, Penzel T, Lips A, Woehrle H, Wewer G, Fietze I. Randomisierte Studie zum Vergleich der Schlaflabor-gesteuerten APAP-Therapie vs. ambulant eingeleiteter Therapie bei Patienten mit OSA (DGSM conference abstract). Somnologie 2018; 22 (Suppl. 01) 1-46.