https://doi.org/10.4081/monaldi.2023.2673
Comparison among three different follow-up models for obstructive sleep apnea syndrome patients: focus on the physiotherapist’s role
Submitted: June 22, 2023
Accepted: September 28, 2023
Published: October 4, 2023
Accepted: September 28, 2023
Abstract Views: 549
PDF_early view: 305
Supplementary: 28
Supplementary: 28
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
In obstructive sleep apnea syndrome (OSAS) subjects different follow-up modalities have been proposed to improve adherence to the continuous positive airway pressure (CPAP) device. This retrospective study compares three different health professional approaches dedicated to caring OSAS patients in three consecutive follow-up periods of 15 months each. The three different follow-up models are: i) physician-oriented follow-up (P-F); ii) physiotherapist-oriented follow-up (PT-F); and iii) tele-titration plus PT-oriented follow-up (TT-PT-F). Health personal visits and actions delivered, patients' adherence, CPAP efficacy, and problems under CPAP use were considered for comparison. Data from 122 OSAS patients with a new prescription of CPAP were analyzed: 39 (32.0%) in the P-F, 38 (31.1%) in the PT-F, and 45 (36.9%) in the TT-PT-F period. We found a reduction over time (from 40.9% in P-F to 8.2% in TT-PT-F, p<0.001) in patients missing the 1-year follow-up visit. The PT-F and TT-PT-F lead to a reduction in physician visits in comparison to P-F (5.2% and 8.9% vs 100%, p<0.001) with no differences in time to the first follow-up visit, CPAP efficacy, and patients’ adherence among the three periods. More device-related problems were found in the PT-F (57.8%), compared with the PF (25.6%) period (p<0.001); the most common troubles were mask problems evaluated in 26.2% of cases. In conclusion, different follow-up models offer similar efficacy and short-term adherence for CPAP leading to a significant reduction in physician visits under the PT-F with or without tele-titration, being mask problems as the most commonly treated. Further analysis should be useful to define the best cost-efficacy follow-up intervention.
Senaratna CV, Perret JL, Lodge CJ, et al. Prevalence of obstructive sleep apnea in the general population: A systematic review. Sleep Med Rev 2017;34:70-81.
DOI: https://doi.org/10.1016/j.smrv.2016.07.002
Peppard PE, Young T, Barnet JH, et al. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol 2013;177:1006-14.
DOI: https://doi.org/10.1093/aje/kws342
Lim DC, Pack AI. Obstructive Sleep Apnea: Update and Future. Annu Rev Med 2017;68:99-112.
DOI: https://doi.org/10.1146/annurev-med-042915-102623
Patil SP, Ayappa IA, Caples SM, et al. Treatment of adult obstructive sleep apnea with positive airway pressure: an American Academy of Sleep Medicine Clinical Practice Guideline. J Clin Sleep Med 2019;15:335-43.
DOI: https://doi.org/10.5664/jcsm.7640
Blau A, Minx M, Peter JG, et al. Auto bi-level pressure relief-PAP is as effective as CPAP in OSA patients--a pilot study. Sleep Breath 2012;16:773-9.
DOI: https://doi.org/10.1007/s11325-011-0574-1
Huseini T, McArdle N, Jasper E, et al. The use and effectiveness of adaptive servo-ventilation in central sleep apnea: a study of consecutive sleep clinic patients. J Sleep Res 2020;29:e13016.
DOI: https://doi.org/10.1111/jsr.13016
Bakker JP, Weaver TE, Parthasarathy S, et al. Adherence to CPAP: what should we be aiming for, and how can we get there? Chest.2019;155:1272-87.
DOI: https://doi.org/10.1016/j.chest.2019.01.012
Pépin JL, Krieger J, Rodenstein D, et al. Effective compliance during the first 3 months of continuous positive airway pressure. A European prospective study of 121 patients. Am J Respir Crit Care Med 1999;160:1124-9.
DOI: https://doi.org/10.1164/ajrccm.160.4.9802027
Pépin JL, Tamisier R, Hwang D, et al. Does remote monitoring change OSA management and CPAP adherence? Respirology 2017;22:1508-17.
DOI: https://doi.org/10.1111/resp.13183
Sawyer AM, Gooneratne N, Marcus CL, et al. A systematic review of CPAP adherence across age groups: clinical and empiric insights for developing CPAP adherence interventions. Sleep Med Rev 2011;15:343-56.
DOI: https://doi.org/10.1016/j.smrv.2011.01.003
Scioscia G, Tondo P, Foschino Barbaro MP, et al. Machine learning-based prediction of adherence to continuous positive airway pressure (CPAP) in obstructive sleep apnea (OSA). Inform Health Soc Care 2022;47:274-82.
DOI: https://doi.org/10.1080/17538157.2021.1990300
Antic NA, Buchan C, Esterman A, et al. A randomized controlled trial of nurse-led care for symptomatic moderate-severe obstructive sleep apnea. Am J Respir Crit Care Med 2009;179:501-8.
DOI: https://doi.org/10.1164/rccm.200810-1558OC
Olsen S, Smith SS, Oei TP, et al. Motivational interviewing (MINT) improves continuous positive airway pressure (CPAP) acceptance and adherence: a randomized controlled trial. J Consult Clin Psychol 2012;80:151-63.
DOI: https://doi.org/10.1037/a0026302
Epstein LJ, Kristo D, Strollo PJ, et al. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med 2009;5:263-76.
DOI: https://doi.org/10.5664/jcsm.27497
Simonelli C, Paneroni M, Vitacca M. An implementation protocol for noninvasive ventilation prescription: the physiotherapist's role in an Italian hospital. Respir Care 2013;58:662-8.
DOI: https://doi.org/10.4187/respcare.01891
Vignatelli L, Plazzi G, Barbato A, et al. Italian version of the Epworth sleepiness scale: external validity. Neurol Sci 2003;23:295-300.
DOI: https://doi.org/10.1007/s100720300004
Pépin JL, Tamisier R, Baguet JP, et al. Fixed-pressure CPAP versus auto-adjusting CPAP: comparison of efficacy on blood pressure in obstructive sleep apnoea, a randomised clinical trial. Thorax 2016;71:726-33.
DOI: https://doi.org/10.1136/thoraxjnl-2015-207700
Vennelle M, White S, Riha RL, et al. Randomized controlled trial of variable-pressure versus fixed-pressure continuous positive airway pressure (CPAP) treatment for patients with obstructive sleep apnea/hypopnea syndrome (OSAHS). Sleep 2010;33:267-71.
DOI: https://doi.org/10.1093/sleep/33.2.267
Johns MW. Daytime sleepiness, snoring, and obstructive sleep apnea. The Epworth Sleepiness Scale. Chest 1993;103:30-6.
DOI: https://doi.org/10.1378/chest.103.1.30
Holmdahl C, Schollin IL, Alton M, et al. CPAP treatment in obstructive sleep apnoea: A randomized, controlled trial of follow-up with a focus on patient satisfaction. Sleep Med 2009;10:869-74.
DOI: https://doi.org/10.1016/j.sleep.2008.08.008
Jambhekar SK, Com G, Tang X, et al. Role of a respiratory therapist in improving adherence to positive airway pressure treatment in a pediatric sleep apnea clinic. Respir Care 2013;58:2038-44.
DOI: https://doi.org/10.4187/respcare.02312
Russo-Magno P, O’Brien A, Panciera T, Rounds S. Compliance with CPAP therapy in older men with obstructive sleep apnea. J Am Geriatr Soc 2001;49:1205-11.
DOI: https://doi.org/10.1046/j.1532-5415.2001.49238.x
Pelletier-Fleury N, Rakotonanahary D, Fleury B. The age and other factors in the evaluation of compliance with nasal continuous positive airway pressure for obstructive sleep apnea syndrome. A Cox’s proportional hazard analysis. Sleep Med 2001;2:225–32.
DOI: https://doi.org/10.1016/S1389-9457(00)00063-0
DeMolles DA, Sparrow D, Gottlieb DJ, et al. A pilot trial of a telecommunications system in sleep apnea management. Med Care 2004;42:764–9.
DOI: https://doi.org/10.1097/01.mlr.0000132353.99209.fe
Smith CE, Dauz ER, Clements F, et al. Telehealth services to improve nonadherence: A placebo-controlled study. Telemed J E Health 2006;12:289-96.
DOI: https://doi.org/10.1089/tmj.2006.12.289
Sparrow D, Aloia MS, DeMolles DA, et al. A telemedicine intervention to improve adherence to continuous positive airway pressure: a randomised controlled trial. Thorax 2010;65:1061-66.
DOI: https://doi.org/10.1136/thx.2009.133215
Stepnowsky CJ, Palau JJ, Marler MR, et al. Pilot randomized trial of the effect of wireless telemonitoring on compliance and treatment efficacy of obstructive sleep apnea. J Med Internet Res 2007;9:e14.
DOI: https://doi.org/10.2196/jmir.9.2.e14
Taylor Y, Eliasson AH, Andrada T, et al. The role of telemedicine in CPAP compliance for patients with obstructive sleep apnea syndrome. Sleep Breath 2006;10:132-8.
DOI: https://doi.org/10.1007/s11325-006-0059-9
Ethics Approval
The study was approved by the Institutional Review Board of Istituti Clinici Scientifici (ICS) MaugeriHow to Cite
Simonelli, Carla, Michele Vitacca, Beatrice Salvi, Manuela Saleri, and Mara Paneroni. 2023. “Comparison Among Three Different Follow-up Models for Obstructive Sleep Apnea Syndrome Patients: Focus on the physiotherapist’s Role”. Monaldi Archives for Chest Disease, October. https://doi.org/10.4081/monaldi.2023.2673.
Copyright (c) 2023 The Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
Similar Articles
- Gianfranco Beghi, Antonio De Tanti, Paolo Serafini, Chiara Bertolino, Antonietta Celentano, Graziella Taormina, Monitoring of hospital acquired pneumonia in patients with severe brain injury on first access to intensive neurological rehabilitation: First year of observation , Monaldi Archives for Chest Disease: Vol. 88 No. 1 (2018)
- Michele Vitacca, Luca Barbano, Daniele Colombo, Olivia Leoni, Enrico Guffanti, Prevalence and variability of use of home mechanical ventilators, positive airway pressure and oxygen devices in the Lombardy region, Italy , Monaldi Archives for Chest Disease: Vol. 88 No. 1 (2018)
- Abhijeet Singh, Rajendra Prasad, Rajiv Garg, Surya Kant, Giridhar B. Hosmane, Abhisek Dubey, Abhisek Agarwal, Ram Kishun Verma, A study to estimate prevalence and risk factors of Obstructive Sleep Apnoea Syndrome in a semi-urban Indian population , Monaldi Archives for Chest Disease: Vol. 87 No. 1 (2017)
- Roberto Porta, Laura Comini, Luca Barbano, Luca Bianchi, Michele Vitacca, A case of obstructive sleep apnea syndrome associated with floppy eyelid syndrome: positive effect of CPAP therapy , Monaldi Archives for Chest Disease: Vol. 87 No. 1 (2017)
- Fiorella Devito, Annapaola Zito, Silvano Dragonieri, Pierluigi Carratù, Vitaliano N. Quaranta, Francesco Vitale, Nicola Quaranta, Francesco Panza, Giancarlo Logroscino, Matteo Cameli, Onofrio Resta, Marco Matteo Ciccone, Evaluation of endothelial function and cardiovascular risk in non-obese patients with slight degree of obstructive sleep apnea syndrome , Monaldi Archives for Chest Disease: Vol. 87 No. 3 (2017)
- Massimiliano Polastri, Lara Pisani, Andrea Dell'Amore, Stefano Nava, Revolving door respiratory patients: A rehabilitative perspective , Monaldi Archives for Chest Disease: Vol. 87 No. 3 (2017)
- Marinella Sommaruga, Elisabetta Angelino, Paola Della Porta, Mara Abatello, Giacomo Baiardo, Gianluigi Balestroni, Ornella Bettinardi, Edward Callus, Chiara Ciracì, Ombretta Omodeo, Claudia Rizza, Paolo Michielin, Marco Ambrosetti, Raffaele Griffo, Roberto F.E. Pedretti, Antonia Pierobon, Best practice in psychological activities in cardiovascular prevention and rehabilitation: Position Paper , Monaldi Archives for Chest Disease: Vol. 88 No. 2 (2018)
- O. Resta, P. Carratù, A. Depalo, T. Giliberti, M. Ardito, O. Marrone, G. Insalaco, Effects of fixed compared to automatic CPAP on sleep in Obstructive Sleep Apnoea Syndrome , Monaldi Archives for Chest Disease: Vol. 61 No. 3 (2004): Pulmonary series
- P. Carratù, G. Karageorgiou, P. Bonfitto, G. Di Gioia, D. Lacedonia, M.P. Foschino Barbaro, O. Resta, Long term evaluation of mental fatigue by Maastricht Questionnaire in patients with OSAS treated with CPAP , Monaldi Archives for Chest Disease: Vol. 67 No. 1 (2007): Pulmonary series
- Roberto F.E. Pedretti, Francesco Fattirolli, Raffaele Griffo, Marco Ambrosetti, Elisabetta Angelino, Silvia Brazzo, Ugo Corrà , Nicolò Dasseni, Pompilio Faggiano, Giuseppe Favretto, Oreste Febo, Marina Ferrari, Francesco Giallauria, Cesare Greco, Manuela Iannucci, Maria Teresa La Rovere, Mario Mallardo, Antonio Mazza, Massimo Piepoli, Carmine Riccio, Simonetta Scalvini, Luigi Tavazzi, Pier Luigi Temporelli, Gian Francesco Mureddu, Cardiac Prevention and Rehabilitation “3.0â€: From acute to chronic phase. Position Paper of the ltalian Association for Cardiovascular Prevention and Rehabilitation (GICR-IACPR) , Monaldi Archives for Chest Disease: Vol. 88 No. 3 (2018)
You may also start an advanced similarity search for this article.
