Comprehensive management of obstructive sleep apnea by telemedicine: Clinical improvement and cost-effectiveness of a Virtual Sleep Unit. A randomized controlled trial

Autoři: Vera M. Lugo aff001;  Onintza Garmendia aff001;  Monique Suarez-Girón aff001;  Marta Torres aff001;  Francisco J. Vázquez-Polo aff005;  Miguel A. Negrín aff005;  Anabel Moraleda aff001;  Mariana Roman aff001;  Marta Puig aff001;  Concepcion Ruiz aff001;  Carlos Egea aff002;  Juan F. Masa aff002;  Ramon Farré aff002;  Josep M. Montserrat aff001
Působiště autorů: Sleep Unit, Respiratory Department, Hospital Clínic, Barcelona, Spain aff001;  Centro de Investigación Biomédica en Red (CIBER) Enfermedades Respiratorias, Madrid, Spain aff002;  Biophysics and Bioengineering Department, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain aff003;  Institut d’Investigacions Biomèdiques Pi i Sunyer (IDIBAPS), Barcelona, Spain aff004;  Quantitative Methods Department and TiDES Institute, Las Palmas de Gran Canaria University, Las Palmas de Gran Canaria, Spain aff005;  Sleep Unit, Respiratory Department, Alava University Hospital, Vitoria, Spain aff006;  Respiratory Unit, San Pedro de Alcántara Hospital, Cáceres, Spain aff007;  Instituto Universitario de investigación Biosanitaria de Extremadura, Cáceres, Spain aff008;  Medicine Department, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain aff009
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: 10.1371/journal.pone.0224069



Obstructive sleep apnea (OSA) is a prevalent disease associated with significant morbidity and high healthcare costs. Information and communication technology could offer cost-effective management options.


To evaluate an out-of-hospital Virtual Sleep Unit (VSU) based on telemedicine to manage all patients with suspected OSA, including those with and without continuous positive airway pressure (CPAP) therapy.


This was an open randomized controlled trial. Patients with suspected OSA were randomized to hospital routine (HR) or VSU groups to compare the clinical improvement and cost-effectiveness in a non-inferiority analysis. Improvement was assessed by changes in the Quebec Sleep Questionnaire (QSQ), EuroQol (EQ-5D and EQ-VAS), and Epworth Sleepiness Scale (ESS). The follow-up was 3 months. Cost-effectiveness was assessed by a Bayesian analysis based on quality-adjusted life-years (QALYs).


The HR group (n: 92; 78% OSA, 57% CPAP) compared with the VSU group (n: 94; 83% OSA, 43% CPAP) showed: CPAP compliance was similar in both groups, the QSQ social interactions domain improved significantly more in the HR group whereas the EQ-VAS improved more in the VSU group. Total and OSA-related costs were lower in the VSU group than the HR. The Bayesian cost-effectiveness analysis showed that VSU was cost-effective for a wide range of willingness to pay for QALYs.


The VSU offered a cost-effective means of improving QALYs than HR. However, the assessment of its clinical improvement was influenced by the choice of the questionnaire; hence, additional measurements of clinical improvement are needed. Our findings indicate that VSU could help with the management of many patients, irrespective of CPAP use.

Klíčová slova:

Cost-effectiveness analysis – Diagnostic medicine – Polysomnography – Quality of life – Questionnaires – Sleep – Telemedicine – Quebec


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