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Typically, patients receive in-person instructions to hook up the home video apnea test devices. Using recorded video instructions would save health care personnel time and improve access to OSA diagnostics for patients in remote areas. The aim of this study was to compare the quality of home sleep apnea test recordings link using in-person and video hookup instructions in a randomized study.
A total of patients aged 18 to 70 years with suspected OSA were randomized to receive either in-person or video hookup instructions for the Nox T3 device Nox Nox, Reykjavik, Iceland. The video quality of the resulting sleep studies was analyzed by determining the number of technically invalid studies. The recording quality of 4 sensors pulse oximeter, nasal cannula, thorax and abdominal respiratory inductance plethysmography belts was assessed by checking nox signal artifacts.
No significant difference was found between the 2 groups in any quality index. This study found no difference in home sleep apnea test recording quality between the 2 groups.
Video hookup instructions are therefore viable and an important step toward a telemedicine-based video of diagnosing OSA. In-person vs video hookup instructions: a comparison of home sleep apnea testing quality.
J Clin Sleep Read article. Keywords: obstructive sleep apnea, telemedicine, home sleep apnea test, video instructions. Using recorded video instructions would save health care personnel time and improve access to obstructive sleep apnea diagnostics for patients in remote areas.
Study Impact: This randomized double-blind study found no discernible difference in the quality of home sleep apnea test recordings when using in-person and video hookup instructions. Video hookup instructions are therefore a viable alternative and an important step toward a telemedicine approach to obstructive sleep apnea diagnosis. Obstructive sleep apnea OSA causes excessive daytime sleepiness and cardiometabolic problems. Traditionally, OSA is diagnosed by polysomnography in a sleep laboratory type 1 sleep study 3.
However, there are several downsides to this. First, patients are less comfortable when sleeping in an unfamiliar environment, 4 leading to reduced sleep efficiency. However, the third downside still remains, requiring patients to receive in-person instructions on how to hook up the HSAT devices or have the devices set up by expert staff.
For hooking up the HSAT devices, the telemedicine group received only an instructional DVD and brochure, whereas the in-person group received instructions from a trained professional at a clinic.
Further research dedicated to the quality of video instructions in HSATs is needed. Therefore, the aim of this study was to perform a randomized double-blind study and compare the quality of type 3 sleep study recordings when using in-person and video hookup instructions. A priori, the authors expected no discernible difference in quality. A total of 27 refused participation. Written consent was obtained from all participants. All participants attended an interview at the hospital, during which they were randomly assigned to either the in-person or video instructions group by lottery.
The in-person instructions group was shown how to hook up the HSAT device by a sleep technologist not fully hooked up for the demonstrationwhile the video instructions group go here given a hyperlink to an online instructional video to watch at home. Participants from both groups were sent home with a Nox T3 device Nox Medical, Reykjavik, Iceland, for type 3 sleep studiesunattached, which they hooked up that night by themselves.
All participants were given the option to call a sleep technologist for help, if necessary. The HSAT device contained the following sensors: a pulse oximeter, a nasal cannula, thorax and abdomen respiratory inductance plethysmography RIP belts, a microphone, and an article source. The instructional video 14 Figure 1which had been translated from English to Icelandic, was almost 6 minutes long and used animations and voiceover to explain the contents of the HSAT kit, how to attach the device and different sensors, and how to start and stop the recording.
The data recorded by the HSAT device was manually assessed by an expert sleep technologist, blinded to the study group of participants, video to the following criteria:. First, the total recording time of the sleep study was determined by detecting when the participant fell asleep for the first time and when he woke up for the last time analysis start and stop time ; only this period was relevant for all additional assessments. This was based on the self-report of the participant in a questionnaire and the manual review of the recording by the sleep technologist.
Finally, artifacts were detected in the signals of 4 sensors pulse oximeter, nasal cannula, thorax and abdomen RIP belts according to the criteria listed in Table 1. Based on these preliminary steps, a study was considered technically invalid if it had fewer than 4 hours of monitoring time. An exception was made for 2 studies with monitoring time of 3. In total, patients were invited to join the study, 27 of those refused. When asked to give a reason for their refusal, 4 patients said they did not feel confident enough to follow a video instruction, 4 did not speak sufficient Icelandic, 2 refused due to disability, 2 did not have enough time to study the video, and 1 person did not have internet access at their home and dating buddies therefore unable to access the video.
A total of 14 patients did not give a reason for their refusal. The study participants were randomly distributed by lottery, 49 to the in-person instructions group and 51 to the video instructions group.
As Table 2 shows, participants in both groups were on average middle-aged and overweight to obese. The majority of participants in both groups were men. No significant difference was found between the 2 groups in demographic variables or OSA severity.
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Comparison of participant characteristics between the in-person and video hookup instructions group. Table 3 illustrates that nearly all conducted sleep studies were valid. For the in-person instructions group, only 1 study was technically invalid. This participant had not put on the HSAT device at all. For the video instructions group, 2 studies were technically invalid: In one case, the pulse oximeter had failed to nox any data.
In the other case, the total recording time was above 4 hours 4. The amount of technically invalid studies was not significantly different between the 2 groups. The same was found for the total recording time and monitoring time. Comparison of overall sleep study quality and sensor signal quality between the in-person and video hookup instructions group. No significant differences were found between the groups in any quality assessment Table 3. The distribution of sensor qualities and outliers was also similar between both groups Figure 3.
This was also found for the nasal cannula, whose recording quality was on average noticeably worse than for the other 3 sensors. Hookup stepsisters finally study found no discernible difference in the quality of HSAT recordings when using in-person and video hookup instructions.
Neither the amount of technically invalid sleep studies varied significantly hookup the 2 groups nox the recording quality of any of the 4 sensors pulse oximeter, nasal cannula, thorax and abdomen RIP belts.
Regarding sensor quality, these results support the findings of Fields et al, 13 who had conducted the only previous study on this topic to date. A possible explanation for this is that the video used in our study may be of higher quality, since the authors reported that some of their study participants found their instructional video confusing. The Fields et al 13 study had a broad scope, exploring the hookup of a telemedicine-based approach to OSA diagnosis and management by observing patients for several months.
During this time span, their primary aim was to compare the functional outcome of automatic positive airway pressure treatment and the level of adherence between the 2 groups; comparing the quality of HSAT recording quality was only an additional, minor aspect.
Our study included a larger sample size of participants and was more demographically diverse. Hookup in all, our study confirmed, strengthened, and generalized the results of Fields et al 13 regarding HSAT recording quality for a wider part of the population and for a different HSAT device.
Additionally, those who did not respond were questioned about their reason for refusing to participate, which revealed a number of relevant insights: First, it is important to make instructional videos available in several languages. Third, technological limitations need to be taken into account, eg, by providing alternative solutions to deliver instructional videos for patients without an internet connection at home.
A limitation of this study is that the demographics of the hookup participants, while more general than in Fields et al, 13 still consisted, on average, of patients who were middle-aged and overweight to obese patients; two-thirds of hookup were men.
While this is not representative of the general population, it is, however, representative of the average patient with OSA. Nonetheless, this study is limited to 1 specific set of circumstances, which limits how much its findings can be generalized.
Also, the study may not be powered to detect minor differences. Future studies should therefore be conducted, eg, with different HSAT devices, in large populations of patients with suspected OSA in other centers to validate and generalize our findings.
Finally, unlike Fields et al, 13 the participants of our study were not interviewed after completing the HSAT about their experience with and opinion of the video hookup instructions. This should be added in future studies on this subject to gain more information about potential improvements to the instructional videos.
New Hook-up Videos for the Nox T3
One of the video of this study is that an analysis of those who did not nox was conducted, since this provides valuable information about concerns patients have regarding video hookup instructions, which need to be addressed in the future. In conclusion, providing hookup instructions for HSATs via recorded video is a viable alternative to providing them in-person.
Video hookup instructions are an important step toward a telemedicine approach to OSA diagnosis, allowing patients in rural or remote areas to receive treatment easily and saving valuable health care personnel time. All authors have seen and approved this manuscript. Work for this study was performed at Landspitali University Hospital data collection and Reykjavik University data analysis and writing. This study was funded by a grant from the Ministry of Health in Iceland.
The other authors report no conflicts of interest. The Emerging Technologies section focuses on new tools and techniques of potential utility in the diagnosis and management of any and all sleep disorders. The technologies may not yet be marketed, and indeed may only exist in prototype form.
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The Journal of Clinical Sleep Medicine and the American Academy of Sleep Medicine expressly do not endorse or represent that any of the technology described in the Emerging Technologies section has proven efficacy or effectiveness in the treatment of human disease, nor that any required regulatory approval has been obtained.
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