JMIR Publications

ABSTRACT

Background:

Despite the importance of diagnosis and treatment, obstructive sleep apnea (OSA) remains a vastly underdiagnosed condition; this is partially due to current OSA identification methods and a complex and fragmented diagnostic pathway.

Objective:

This prospective, single-arm, multi-state feasibility pilot study was undertaken to understand the journey in a non-referred sample of participants through the fully remote OSA screening, diagnostic, and treatment pathway, using the Primasun Sleep Apnea Program (PSAP).

Methods:

Participants were recruited on the internet from North Carolina and Texas to participate in the study entirely virtually. Eligible participants were invited to schedule a video telemedicine appointment with a board-certified sleep physician, who could then order a home sleep apnea test (HSAT) to be delivered to the participant's home. Results were interpreted by the sleep physician and communicated to the participant during a second video telemedicine appointment. Participants who were diagnosed with OSA during participation in the study and prescribed a positive airway pressure (PAP) device were instructed to download the PSAP App, which provides educational and support-related content, and access to personalized coaching support during the study 90-day PAP usage period. Surveys were deployed throughout the study to assess baseline characteristics, prior knowledge of sleep apnea, and satisfaction with the program.

Results:

For the 157 individuals who were ordered an HSAT, it took a mean of 7.4 ± 2.6 days and median 7.1 days (IQR: 2.0) to receive their HSAT after they completed their first televisit appointment. For the 114 individuals who were diagnosed with OSA, it took a mean of 13.9 ± 9.6 days and median 11.7 days (IQR: 10.1) from receiving their HSAT to being diagnosed with OSA during their follow-up televisit appointment. Overall, the mean and median time from first televisit appointment to receiving an OSA diagnosis was 21.4 ± 9.6 days and 18.9 days (IQR: 9.2) respectively. For those who were prescribed PAP therapy, it took a mean of 8.1 ± 9.3 days and median 6.0 days (IQR: 4.0) from OSA diagnosis to initiation PAP therapy.

Conclusions:

These results demonstrate the possibility of a highly efficient, patient-centered pathway for OSA workup and treatment. Such findings support pathways which could increase access to care, reduce loss to follow up, and reduce health burden and overall cost. The program’s ability to efficiently diagnose patients who otherwise may have not been diagnosed with OSA is important, especially during a pandemic as the country shifted to virtual and remote care models and may sustain this direction. The potential economic and clinical impact of the program’s short and efficient journey time, and low attrition rate should be further examined in future analyses. Future research also should examine how a fast and positive diagnosis experience impacts success rates for PAP therapy initiation and short and long-term adherence. Clinical Trial: NCT04599803