Telehealthcare interventions in the management of obstructive sleep apnoea/ hypopnoea syndrome.
Abstract:
Obstructive sleep apnoea hypopnoea syndrome (OSAHS) is defined as a condition during sleep where there is repeated collapse or closure of the pharyngeal airway resulting in apnoeic and or hyponoeic episodes that can range from mild to moderate to severe depending on how many episodes of these occur per hour of sleep. The symptomatic consequences of OSAHS are numerous and sufferers may report a combination of excessive daytime somnolence, loud and disruptive snoring, a sensation of nocturnal choking and gasping, poor and unrefreshing sleep, mood changes, impaired alertness (sometimes when driving), morning headaches, nocturia and decreased libido.
Telehealthcare solutions to support the clinical review of patients with a diagnosis of OSAHS who are using Continuous Positive Airway Pressure (CPAP) therapy have significant potential to deliver person centred, safe, and effective care that is closer to home There are also potential benefits for patients and clinicians in terms of reduced travel, fuel consumption and environmental impact in terms of reduced carbon emissions. It has the potential to deliver equivalent clinical care for people living in remote and rural areas distant to the main centre of care and this can have a significant impact on time taken off work to travel to sleep centres to undergo diagnostic and treatment interventions.
My PhD project aims to answer the following questions related to OSAHS:
- What are the potential roles and effectiveness of telehealthcare review in OSAHS management compared to usual face to face care?
- What are the measurable effects of telehealthcare review in OSAHS management on travelling time for clinicians and service users compared to usual face to face care?
- What are the measurable effects of telehealthcare review in OSAHS in terms of distance travelled and carbon emissions compared to usual face to face care?
- What are the effects of telehealthcare review on patient satisfaction in OSAHS management compared to usual face to face care?
PhD project timeline:
- Develop tele sleep clinic review service – identifying current evidence base, identifying and developing theoretical underpinning, and scoping/modelling key aspects 2014-2016.
- Undertake iterative process of refining tele sleep clinic intervention with stakeholders 2016.
- Pilot RCT 2017-2018 using quantitative and qualitative methods to:
– assess feasibility,
– Acceptability
– Potential impact of service delivery on clinical and cost effectiveness,
– Environmental impact compared to face to face review.
Learning outcomes to date from conducting a systematic review (Prospero 2015:CRD42015019455) are:
- Tele sleep clinic review in CPAP users may be as effective as face to face care
- Evidence limited to small, generally low quality pilot studies
- Fully-powered well designed studies required to demonstrate clinical and cost effectiveness of using telehealthcare to access specialist sleep services remotely.
My PhD aims to define the role of Telehealthcare solutions to support the clinical review of patients with a diagnosis of OSAHS who are using CPAP therapy compared to usual face to face care. Telehealthcare interventions have the significant potential to deliver person centred, safe, timely and cost effective healthcare delivery that is closer to people’s homes. There are other potential benefits for patients and clinicians in terms of reduced travel, fuel consumption and the environmental impact in terms of reduced carbon emissions. It has the potential to deliver equivalent clinical care for people living in remote and rural areas and this may have a significant impact on the economy in terms of loss of working hours for patients to travel to sleep centres to undergo diagnostic and treatment interventions. If the findings of this research project are significantly in favour of a telehealthcare model this will be an important finding for providers of sleep medicine healthcare globally.