Feasibility and efficacy of active remote monitoring of home ventilation in pediatrics.

Abstract

BACKGROUND\nNon-invasive positive airway pressure (PAP) therapy is used to treat children with sleep-disordered breathing. Effective management requires good adherence. In response to the problem of reduced adherence over time, a pilot study using ventilators equipped with technology to remotely monitor home adherence was undertaken.\n\n\nMETHODS\nFrom July 2019, children requiring PAP therapy consented for remote monitoring. Data collected included ventilator usage, apnea-hypopnea index (AHI), and mask leak. Parents were contacted on Days 14, 42, and 90 post-establishment. A proforma was used to assess parental understanding and ways to improve therapy adherence. A parental feedback questionnaire was completed on Day 90 of the study.\n\n\nRESULTS\nMedian nightly PAP usage over 90-day\xa0post-establishment was 6.58\u2009h (interquartile range: 2.47-8.62); 60% of patients met criteria for good adherence (>4\u2009h for >70% of nights). There was a decrease in median nightly usage in Week 1 (6.92\u2009h) versus Week 12 (6.15\u2009h), p\u2009= \u20090.04. Mask leak was higher in Week 1 (17.7\u2009L/min) versus Week 12 (14.7\u2009L/min), p\u2009= \u20090.053. There was no significant difference in AHI between Week 1 (2.7/h) versus Week 12 (2.3/h), p\u2009= \u20090.75.\xa045% of questionnaire respondents felt active remote monitoring\xa0positively influenced PAP usage, whilst 84% reported overall satisfaction with PAP therapy.\n\n\nCONCLUSIONS\nRemote monitoring technology has the potential to guide adjustments in PAP therapy, monitor and improve adherence in children, and reduce the burden of hospital-based review. Preliminary work shows high approval from parents.