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      Proposed management model for the use of telemonitoring of adherence to positive airway pressure equipment - position paper of the Brazilian Association of Sleep Medicine - ABMS

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          Abstract

          This document “Proposed management model for the use of telemonitoring to positive airway pressure adherence” was prepared by a special commission of the Brazilian Association of Sleep Medicine, with the objective of recommending a follow-up model for patients undergoing positive airway pressure therapy using telemonitoring. This proposal was prepared based on a survey and analysis of the most up-to-date national and international literature and uses the best available evidence to facilitate the standardization of care by Sleep Science specialists with potential benefit for patients. Among the conclusions of the document, it is emphasized that telemonitoring is an important tool that allows health professionals trained in sleep-disordered breathing to remotely monitor PAP therapy, allowing prompt and, when necessary, daily adjustments to be made in order to increase adherence to treatment. The authors also conclude that the privacy of the data received and shared during the provision of telemonitoring must be respected by the physician or health professional trained in sleep, with the authorization of the patient and/or person responsible, who should be made aware of the short-, medium- and long-term provision of the service.

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          Most cited references71

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          Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis

          There is a scarcity of published data on the global prevalence of obstructive sleep apnoea, a disorder associated with major neurocognitive and cardiovascular sequelae. We used publicly available data and contacted key opinion leaders to estimate the global prevalence of obstructive sleep apnoea.
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            Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study.

            The effect of obstructive sleep apnoea-hypopnoea as a cardiovascular risk factor and the potential protective effect of its treatment with continuous positive airway pressure (CPAP) is unclear. We did an observational study to compare incidence of fatal and non-fatal cardiovascular events in simple snorers, patients with untreated obstructive sleep apnoea-hypopnoea, patients treated with CPAP, and healthy men recruited from the general population. We recruited men with obstructive sleep apnoea-hypopnoea or simple snorers from a sleep clinic, and a population-based sample of healthy men, matched for age and body-mass index with the patients with untreated severe obstructive sleep apnoea-hypopnoea. The presence and severity of the disorder was determined with full polysomnography, and the apnoea-hypopnoea index (AHI) was calculated as the average number of apnoeas and hypopnoeas per hour of sleep. Participants were followed-up at least once per year for a mean of 10.1 years (SD 1.6) and CPAP compliance was checked with the built-in meter. Endpoints were fatal cardiovascular events (death from myocardial infarction or stroke) and non-fatal cardiovascular events (non-fatal myocardial infarction, non-fatal stroke, coronary artery bypass surgery, and percutaneous transluminal coronary angiography). 264 healthy men, 377 simple snorers, 403 with untreated mild-moderate obstructive sleep apnoea-hypopnoea, 235 with untreated severe disease, and 372 with the disease and treated with CPAP were included in the analysis. Patients with untreated severe disease had a higher incidence of fatal cardiovascular events (1.06 per 100 person-years) and non-fatal cardiovascular events (2.13 per 100 person-years) than did untreated patients with mild-moderate disease (0.55, p=0.02 and 0.89, p<0.0001), simple snorers (0.34, p=0.0006 and 0.58, p<0.0001), patients treated with CPAP (0.35, p=0.0008 and 0.64, p<0.0001), and healthy participants (0.3, p=0.0012 and 0.45, p<0.0001). Multivariate analysis, adjusted for potential confounders, showed that untreated severe obstructive sleep apnoea-hypopnoea significantly increased the risk of fatal (odds ratio 2.87, 95%CI 1.17-7.51) and non-fatal (3.17, 1.12-7.51) cardiovascular events compared with healthy participants. In men, severe obstructive sleep apnoea-hypopnoea significantly increases the risk of fatal and non-fatal cardiovascular events. CPAP treatment reduces this risk.
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              Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline.

              This guideline establishes clinical practice recommendations for the diagnosis of obstructive sleep apnea (OSA) in adults and is intended for use in conjunction with other American Academy of Sleep Medicine (AASM) guidelines on the evaluation and treatment of sleep-disordered breathing in adults.
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                Author and article information

                Journal
                Sleep Sci
                Sleep Sci
                ssci
                Sleep Science
                Brazilian Association of Sleep and Latin American Federation of Sleep
                1984-0659
                1984-0063
                Jan-Mar 2021
                Jan-Mar 2021
                : 14
                : Spec 1
                : 31-40
                Affiliations
                [1 ] Universidade Federal de São Paulo (UNIFESP), Departamento de Psicobiologia - São Paulo - São Paulo - Brazil.
                [2 ] Universidade Federal de São Paulo (Unifesp), Dep. de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço - São Paulo - São Paulo - Brazil.
                [3 ] Hospital Israelita Albert Einstein, Dep. de pacientes graves e Terapia PAP -São Paulo - São Paulo - Brazil.
                [4 ] Hipnos Assessoria e Produtos para o Sono, Adaptação e monitoramento Terapia PAP - Curitiba - Paraná - Brazil.
                [5 ] Universidade Federal de São Paulo (UNIFESP) Departamento de Pediatria -São Paulo - São Paulo - Brazil.
                [6 ] Sleep Laboratory, Pulmonary Division, Heart Institute (InCor), Hospital das Clinicas HCFMUSP, Universidade de São Paulo - São Paulo - São Paulo - Brazil.
                Author notes
                [* ] Corresponding author: Tatiana Aguiar Vidigal E-mail: tatividigal@ 123456yahoo.com.br
                Article
                10.5935/1984-0063.20200086
                8663734
                34917271
                782cb7c2-d183-407a-a909-d6b22082d7d3

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 10 August 2020
                : 09 December 2020
                Categories
                Original Article

                obstructive sleep apnea,cpap adherence,telemonitoring

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