Telemedicine home CPAP titration and follow-up in the COVID-19 scenario

Introduction: Continuous positive airway pressure (CPAP) titration was dramatically affected by the coronavirus disease 2019 pandemic due to increased biological risk. This study aims to compare successful CPAP adaptation and compliance with home telemedicine CPAP titration with the usual method based on face-to-face visits. Methodology: A prospective cohort using telemedicine home-CPAP titration and follow-up during the COVID-19 pandemic (TC) was compared with a retrospective cohort receiving face-to-face pre-pandemic home titration (RC). The TC included a subgroup with a smartphone application (APP). Successful CPAP adaptation and compliance at one month of follow-up were the main endpoints, while patient satisfaction and costs were secondary endpoints. Results: 210 consecutive patients were evaluated (80 RC, 130 TC). 36 patients used APP (TC-APP). CPAP titration was successful in 90% in RC vs 95% in TC (p-value 0.346) and 100% in TC-APP (p-value 0.222). No differences between groups were found at one month of compliance (4.79 h/d RC, 4.33 h/d TC, 4.59 h/d TC-APP). Patient satisfaction out of 10 was 7.69 (SD 2.05) in RC versus 9.02 (SD 0.64) in TC (p-value <0.001). 64% of the TC-APP subgroup reported that their telemedicine strategy influenced in an increase in CPAP use (p-value 0.011). CPAP adaptation with follow-up had an estimated direct staff cost per patient of €19.61 (SD 8.61) in TC-noAPP (TC no APP used) against €23.79 (SD 9.94) in TC-APP (p-value 0.048). Conclusions: Telemedicine in CPAP titration and early follow-up is equivalent to the usual care in terms of successfully adaption and compliance, while achieving a greater patient satisfaction.