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

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.

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

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

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.

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

Example of good adherence

Example of poor adherence

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

Main telemonitoring view of users

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)

Results Remaining 6 APAP users – The remaining 19 CPAP users average adherence 6.50 hrs per night residual AHI of 0.1-22 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

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 51. 8 (now discontinued therapy)

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

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

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

The potential role of telemonitoring in people with OSAS using CPAP