The Effect of Remote Diagnosis and Treatment on 24 Hour Ambulatory Blood Pressure Rhythm of OSA Patients

NCT ID: NCT06064630

Last Updated: 2023-10-03

Basic Information

• Recruitment Status: UNKNOWN
• Clinical Phase: NA
• Total Enrollment: 300 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2023-10-15
• Study Completion Date: 2024-08-15

Brief Summary

Epidemiological studies have shown that OSA is closely related to the occurrence and development of cardiovascular diseases, especially hypertension. At present, there are 66 million patients with moderate to severe OSA in China, and the current diagnosis and treatment of OSA is mainly completed in the sleep center of the hospital, which is time-consuming and laborious, resulting in the delayed diagnosis and treatment of a large number of patients, making about 80% of potential OSA patients have not been diagnosed and treated in time. With the development of the Internet technologies, telemedicine has been increasingly applied to the diagnosis, treatment and management of chronic diseases with its advantages of convenience, interactivity, efficiency, sharing, coherence and breaking through the limitations of time and space. Our center has initially built a remote diagnosis and treatment management model for OSA. Compared with the traditional medical model, the medical and health economic analysis shows that the OSA diagnosis and treatment model based on telemedicine is more cost-effective, but its clinical efficacy needs to be further verified. Hypertension is a common complication in OSA patients, and continuous positive airway pressure (PAP) has a significant hypertensive effect in the treatment of OSA. However, whether clinical management based on remote diagnosis and treatment mode can achieve the same therapeutic effect as traditional face-to-face diagnosis and treatment mode in improving ambulate blood pressure in OSA patients needs to be further clarified. This study will compare the improvement of ambulatory blood pressure management in patients with hypertension under the new telemedicine mode and the traditional medical mode through a single-center randomized controlled trial, so as to optimize the diagnosis and treatment process of OSA patients with hypertension, establish a more convenient and efficient remote diagnosis and treatment mode with reliable clinical outcome, and provide a theoretical basis for subsequent multi-center research and promotion

Detailed Description

Patients who came to the hospital for snoring were randomly divided into the telemedicine group and the outpatient group, and the ambulatory blood pressure values and rhythm changes of the two groups were extracted. The 24-hour ambulatory blood pressure improvement of OSA patients in the telemedicine group and the outpatient group after 3 months of APAP treatment were compared. Investigators will also compare the OSA-related health care costs (i.e., sleep studies, staff salaries), patient costs (travel expenses incurred by patients and lost productivity due to medical visits), and total costs that sum the two between the two groups of patients for health cost-effectiveness . At the same time, the differences in compliance between the telemedicine group and the outpatient group and the improvements of subjective symptoms estimated by questionnaires after APAP treatment were compared, and the changes in OSA related cardiovascular risk biomarkers and metabolomics assessments after 3 months of APAP treatment between the telemedicine group and the outpatient group were compared, so as to explore the mechanism of APAP treatment to improve the ambulate blood pressure rhythm of OSA patients. In addtion, the subtypes of OSA will be classified according to the characteristics of sleep symptoms and sleep monitoring variables, and the response of different subtypes of OSA to blood pressure improvement after APAP treatment will be evaluated in our study，so as to lay foundation for precise treatment of OSA. Investigators has begun to recruit patients for the pilot study on July 1, and is progressing smoothly.

Conditions

Sleep Apnea, Obstructive

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: SINGLE

Study Groups

Telemedicine treatment group

Telemedicine group need to complete sleep-related questionnaires on the Redcap website. Participants in the telemedicine group will learn Home sleep apnea testing(HSAT) online and then complete overnight monitoring at home. Patients diagnosed with OSA after HSAT monitoring will receive standardized APAP treatment. At 1 month of APAP treatment, participants in the telemedicine group will be followed up by phone/video to check their APAP treatment compliance and prompted to complete the corresponding follow-up questionnaire on the Redcap website. After 3 months of APAP treatment, the telemedicine group will be followed up by phone/video to check their APAP treatment compliance at 3 month, and they will finish corresponding follow-up questionnaires on Redcap website. 24-hour ambulatory blood pressure monitoring, and physical measurements will be conducted in sleep center at 1 month and 3 month.

Group Type: OTHER

Automatic continuous positive airway pressure

Intervention Type: DEVICE

Automatic continuous positive airway pressure (APAP) is the routine and first line treatment for patients with sleep apnea

Outpatient treatment group

Outpatient group need to complete sleep-related paper questionnaires at sleep center. The sleep technicians will explain to the patients how to use the Home sleep apnea testing (HSAT) and then they will complete overnight monitoring at home. Patients diagnosed with OSA after HSAT monitoring will receive standardized APAP treatment. At 1 month of APAP treatment, participants in the outpatient group will be followed up at sleep center to check their APAP treatment compliance and prompted to complete the corresponding follow-up paper questionnaires at sleep center. After 3 months of APAP treatment, the outpatient group will be followed up to check their APAP treatment compliance at 3 month, and they will finish corresponding follow-up paper questionnaires at sleep center. 24-hour ambulatory blood pressure monitoring, and physical measurements will be conducted in sleep center at 1 month and 3 month.

Group Type: OTHER

Automatic continuous positive airway pressure

Intervention Type: DEVICE

Automatic continuous positive airway pressure (APAP) is the routine and first line treatment for patients with sleep apnea

Interventions

Automatic continuous positive airway pressure

Automatic continuous positive airway pressure (APAP) is the routine and first line treatment for patients with sleep apnea

Intervention Type: DEVICE

Eligibility Criteria

Inclusion Criteria

1. Suspected OSA and recommended to sleep center for HSAT monitoring;

2. Voluntary and signed informed consent;

3. Voluntary and can complete 24-hour ambulatory blood pressure monitoring and blood sample collection at the first visit and at 3 months follow-up;

4. Access to the Internet, email and phone calls;

5. Lived in Beijing for the last three months (subjects randomly assigned to the outpatient treatment group were able to travel to and from the sleep center);

6. Fluent Chinese expression;

Exclusion Criteria

1. Blood pressure cuff should not be used (e.g., circumference of upper arm > 55cm, history of breast cancer, structural lesions of upper limb);

2. Has been treated with a CPAP or oral appliance;

3. Cardiac insufficiency, NYHA classes III-IV;

4. Clear central sleep apnea (AHI≥15 times/hour, central events > 50%);

5. Expected life span < 2 years;

6. Pregnant women;

7. History of kidney failure or kidney transplantation;

8. Attention deficit hyperactivity disorder, use of wakefulness drugs;

9. Less than 5 hours of sleep per night on weekdays combined with other sleep problems (e.g., shift work, night shift, circadian rhythm disturbance);

10. Oxygen is needed when awake or sleeping;

11. Unstable condition: unstable angina pectoris, uncontrolled hypertension, severe COPD, tumor progression, or unstable mental illness;

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 75 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Peking University People's Hospital

OTHER

Sponsor Role: lead

Responsible Party

Xiaosong Dong

Clinical Professor

Responsibility Role: PRINCIPAL_INVESTIGATOR

Central Contacts

Huijie Yi

Role: CONTACT

2011110194@stu.pku.edu.cn

01088324207

Other Identifiers

2022PHB359-001

Identifier Type: -

Identifier Source: org_study_id