1. Real life experience of telemonitoring in a remote and rural sleep medicine service.
Phyllis Murphie- Respiratory Nurse Consultant/PhD candidate
Robin Paton, Ross Paton, Musa Ali, Jane Gysin, Stuart Little
REG Summit 2017

2. The potential roles of telemonitoring in people with Sleep disordered breathing
Telemonitoring in people with Sleep Apnoea, Obesity Hypoventilation, Neuromuscular diseases has the potential to deliver care that is:
Person centred, Closer to home, reducing travel time and fuel consumptions, kinder to the environment, can free up clinical sessions by reinvesting travelling time in clinical care, reduced time of work for service users.

3. Background Population 148,000 Remote/rural -2,500 square miles
Considerable commuting time/ distances, involved attending centralised review clinics
Round trip 150 miles/ 4 hours

4. Background
We manage people with a diagnosis of : (OSAHS), obesity hypoventilation syndrome (OHS), and neuromuscular disorders (ND's).
Treatment options we offer are CPAP/APAP/NIV for more complex sleep disordered breathing

5. Real time telemonitoring platform
Aim : Review potential benefits of telemonitoring in our sleep medicine service.
Real time telemonitoring platform
S 10 Airsense Elite, Autoset, VPAP ST, ASV devices
Phillips Dreamstation
In 2015 we initiated telemonitoring with continuous /automatic positive airway pressure (CPAP/APAP) and non-invasive ventilation (NIV) devices that facilitate efficacy data transfer via an inbuilt SIM card to a secure website for those commenced on treatment for the first 30 days following initiation.
There is also the option for long term telemonitoring where this is thought to be appropriate in individual cases.

6. Methods Review the telemetry data in terms of:
adherence to therapy,
mask fit
efficacy of CPAP and NIV therapy
Assess the impact of telemonitoring on service delivery

7. Example of good adherence

8. Example of poor adherence

9. So how does it work? SIM Card in device/also has data card
SIM can access any mobile network
Enter new patient data and device numbers on website
Password protected
Enter prescription
Pressure settings, ramp, EPR level, humidification settings, back up RR
Data transmitted daily to secure website
Data can be viewed at any time

10. Main telemonitoring view of users

11. Results Telemonitoring data available for: 7 were using APAP devices
26 patients commenced on CPAP/APAP
22 commenced on NIV
7 were using APAP devices
one non adherent individual (machine recalled)

12. Results Remaining 6 APAP users – The remaining 19 CPAP users
average adherence 6.50 hrs per night
residual AHI of
no mask leak issues
The remaining 19 CPAP users
average adherence 6.55 hours/night
residual AHI of 0.5 – 41(1 patient)
4 had high mask leaks

13. Results Those commenced on NIV Remaining 20 NIV users (OSA/OHS)
2 with diagnosis of neuromuscular disease
adherence of 8-11 hours/night
no mask fit issues
Remaining 20 NIV users (OSA/OHS)
average adherence 7 hours/night
residual of AHI of 0.2 – 10
8 unacceptable high mask leakage
1 non adherent user (58 mins per night) had a residual AHI of (now discontinued therapy)

14. Conclusions
Our experience of telemonitoring is positive and allows us to:
monitor treatment adherence
monitor treatment efficacy data remotely
intervene where necessary
Where poor adherence with therapy/high mask leaks seen via the telemonitoring platform this prompts
telephone review and/or a clinic follow up
No adverse outcomes reported

15. Conclusions
Data transmission has been unproblematic and adherence/efficacy data can be viewed as needed
Machine pressure settings and other parameters can be adjusted remotely
We propose that telemonitoring of CPAP/APAP/NIV use is advantageous for patients/clinicians
We are now planning to conduct a pilot randomised controlled trial in 2018 to research this further

16. Real time telemonitoring considerations - what does it add your current service?
Information governance at organisational level
Costs of telemonitoring data in addition to current service provision
Additional work to monitor and review service user data
Oversight of new patient introduction to therapies and adherence/ treatment efficacy
Increased staff time to review telemonitoring data

17. The potential role of telemonitoring in people with OSAS using CPAP