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

Early Access
Submitted: June 22, 2023
Accepted: September 28, 2023
Published: October 4, 2023
OSAS, CPAP, sleep apnea disorders, rehabilitation
Abstract Views: 596
PDF_early view: 331
Supplementary: 31
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Authors

Carla Simonelli
https://orcid.org/0000-0003-2238-7499
Cardio-Respiratory Rehabilitation, ICS Maugeri IRCCS, Institute of Lumezzane (BS), Italy.
Michele Vitacca
https://orcid.org/0000-0002-9389-7915
Respiratory Rehabilitation, ICS Maugeri IRCCS, Institute of Lumezzane (BS), Italy.
Beatrice Salvi
https://orcid.org/0000-0001-7203-4320
Cardio-Respiratory Rehabilitation, ICS Maugeri IRCCS, Institute of Lumezzane (BS), Italy.
Manuela Saleri
Cardio-Respiratory Rehabilitation, ICS Maugeri IRCCS, Institute of Lumezzane (BS), Italy.
Mara Paneroni
mara.paneroni@icsmaugeri.it
https://orcid.org/0000-0003-3982-2098
Cardio-Respiratory Rehabilitation, ICS Maugeri IRCCS, Institute of Lumezzane (BS), Italy.

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.

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Crossref
Scopus
Google Scholar
Europe PMC
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) Maugeri

How 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.
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