June 07, 2017 - Healthcare providers are turning to mHealth technology to make CPAP therapy more productive – for both doctors and patients.
Continuous positive airway pressure (CPAP) machines have been around for decades, helping doctors to monitor patients with breathing problems, like obstructive sleep apnea (OSA). But the clunky devices, which typically consist of an airflow generator, hose and full face mask, aren’t comfortable, and often prevent the patient from getting a good night’s sleep.
Now companies like ResMed, SRETT and Philips Respironics are developing mobile health platforms that connect wirelessly to the CPAP machines and care providers, enabling patients to use the devices at home, rather than in a sleep lab. With that online connection, data from CPAP devices, including vital signs and sleep activity, is transmitted to providers, who in turn can track and identify problems and intervene, or offer coaching and support.
Sharon Schutte-Rodin, MD, a clinical professor of medicine at the University of Pennsylvania’s Perelman School of Medicine, says remote monitoring platforms like ResMed's AirView are important to doctors tracking the efficacy of sleep apnea therapy. And the advent of mHealth technoilogy ahs improved a process that was once restricted to the lab.
“The gold standard has always been the lab," she says. But labs can be expensive to maintain, and they're not comfortable for patients.
“(Y)ou end up getting good breathing data, but no sleep data,” she says.
Ulimately, she says, CPAP research can best be done when the patient is at home, and when the doctor can combine data from that environment with the patient's medical record.
"CPAP therapy units are part of the exciting new e-health technology that allows patients to view daily sleep therapy data, to interact with web-based patient education and to receive care reminders and therapy data alerts," Schutte-Rodin says. "Additionally, the e-device data has been integrated via daily modem exports directly into the patient’s EHR medical record."
The improvements go both ways. While doctors and researchers draw better data from CPAP therapy to analyze and diagnose sleep and breathing problems, that extra support often gives patients more of an incentive to follow doctors’ orders on treatment.
Just last year, Kaiser Permanente released the results of a study conducted with ResMed’s AirSense platform that indicated patients using mHealth-enabled CPAP therapy saw their adherence rates jump more than 20 percent over three months.
“Anything that significantly increases CPAP use in the first 90 days is a big deal,” Dennis Hwang, MD, a sleep specialist at Kaiser Permanente’s Fontana Medical Center and the study’s principal investigator, said in a press release. “That initial period is crucial for patients to embrace CPAP to treat their sleep apnea, which is linked to heart failure, atrial fibrillation, type 2 diabetes and other serious conditions. Tools like U-Sleep hold a lot of promise for patients on CPAP and the clinicians who treat them.”
The Centers for Disease Control and Prevention estimates that there are 50 million to 70 million adults in the U.S. who suffer from a sleep or wakefulness disorder such as sleep apnea. The downhill costs are substantial: loss of productivity at work or school, behavioral health issues, even leading to or exacerbating chronic conditions.
That’s why the market is growing. Market research company Berg Insight reports that the number of remotely monitored patients in the U.S. – defined as patients taking part in an mHealth program with a connected medical device - jumped 44 percent in 2016, to 7.1 million people, and that number is expected to grow to 50.2 million by 2021.
According to Berg researchers, sleep therapy and heart monitoring accounted for some 80 percent of that growth. Sleep therapy alone grew 70 percent in 2016.
So anything that can help someone get a good night’s sleep stands to make a huge impact on clinical costs down the road.
But like any other mHealth or telehealth program, one of the biggest challenges is getting accurate data to the doctor.
The idea is “to get the data to the doctors without interference, inefficiency or missed connections,” says Jeremy Malecha, ResMed’s vice president of product management in healthcare and informatics.
Prior to using mHealth-enabled devices, he says, patients either filled out forms and mailed them back to their doctors, or they brought their CPAP machines to the doctor’s office every few weeks or months so that the data could be downloaded. In some instances a home health aide would show up at the patient’s door, collect the information and fax it to the doctor’s office.
By automating that process with mHealth platforms, Malecha says, doctors get unfiltered data from the CPAP devices, and can act more quickly on that information. They can also more easily include patients in the process.
“With mHealth, patients are staying engaged and are adhering to therapy,” says Malecha, whose company is introducing a smaller, more travel-friendly CPAP device, called the AirMini, and is eyeing the COPD and ventilation markets as well.
“There are more and more opportunities for the data to be made more seamless,” he says.
CPAP therapy is just one segment of the sleep tracking industry, which has been growing for several years as healthcare providers, behavioral health experts and even the Veterans’ Administration look for ways to diagnose the reasons for bad sleep and find ways to improve sleeping.
Aside from wireless CPAP devices, researchers have been working with wearables - including smart clothing, activity bands and smartwatches - and sensors placed under the mattress to measure everything from breathing rates to restlessness.
Even Apple is getting into bed. The tech giant recently announced the acquisition of Beddit, a Finnish company whose $150 Beddit Sleep Tracker sensor is slipped under the mattress to measure total sleep time, resting heart rate, respiration rate, how long it takes to fall asleep, restlessness and deep sleep. An Android or iOS app offers analysis and feedback.
Apple is also playing a role in an ongoing clinical trial targeting sleep issues. The company’s ResearchKit platform is being used, in conjunction with the IBM Watson Health Cloud, in the SleepHealth Study being conducted by the American Sleep Apnea Association.
ASAA officials say the SleepHealth App has been downloaded by more than 20,000 users in the year that the study has been up and running, and roughly half have opted in as participants in the study.
Schutte-Rodin sees another advantage to mHealth platforms that connect patients and their therapy data to healthcare providers.
With the advent of consumer-facing wearables like activity trackers and smartwatches, people are tracking their own sleep at home – but they don’t know how to interpret the data. They may see several interruptions to their sleep pattern every hour and think they’re having problems sleeping, when they're actually experiencing normal sleep movements. In addition, providers might have problems verifying data from the wide variety of wearables on the market.
“Sometimes too much data can cause problems, or unvalidated data can cause misinterpretation or miscommunication,” she points out. “You need [a platform] that can connect to a doctor to provide feedback.”