CLINICAL CARE STRATEGIES FOR THE DIAGNOSIS AND MANAGEMENT OF ADULT PATIENTS WITH RESPIRATORY SLEEP DISORDERS

Abstract

Many patients with obstructive sleep apnoea (OSA) in the UK remain undiagnosed, and untreated. Conventional clinical care for OSA diagnosis and management is insufficient to meet the increasing demand, which has been exponentially rising post-pandemic.

This Thesis investigated new clinical care strategies for the diagnosis and management of OSA and evaluated patient experiences with, and preferences for, these strategies. Quantitative and qualitative investigations in adult patients with suspected or existing OSA diagnosis were conducted.

In a randomised controlled pilot study, patients referred for suspected OSA were investigated using novel mandibular movement (MM) monitoring with automated machine-learning analysis. Reduced time to treatment decision and saved healthcare professionals’ time, were found compared to conventional home respiratory polygraphy.

In a qualitative evaluation, nested study, within the randomised controlled study, patients described their journeys to OSA diagnosis. They expressed their preference for home OSA testing with the “unobtrusive” MM monitor, compared to the more “cumbersome and restrictive” respiratory polygraphy.

In a systematic review and meta-analysis, virtual care via telephone or video consultations was found to be as effective as in-person consultations for improving subjective sleepiness in patients treated with continuous positive airway pressure (CPAP). Virtual care also appeared to be less costly than in-person care strategies.

In a UK survey of patients with self-reported OSA treated with CPAP, most patients reported being satisfied with their CPAP initiation experience. Most patients also expressed their preference for in-person CPAP initiation and follow-up care, compared to remote care strategies.

These findings show that digitally-enabled clinical care can be considered for OSA diagnosis and management. However, remote care pathways for OSA may not accommodate the preferences and needs of all patients, specifically those at higher risk of being digitally excluded. Thus, future investigations should address potential health inequalities associated with widespread implementation of remote care pathways for OSA.