Authors (including presenting author) :
Tang WT, Tse PY, Ip KL, Yu HY, Chiu PH, Chow MC, Tsai MK, Lam YF, Ng ML, Miu PL
Affiliation :
Department of Medicine, Pamela Youde Nethersole Eastern Hospital
Introduction :
OSA is associated with significant health consequences, with CPAP being the gold standard treatment. Traditionally, CPAP is initiated following a single-night inpatient titration. With its long waiting time and technology advancements, home CPAP titration became an alternative. However, absence of onsite monitoring can lead to negative patient experiences, poor compliance and titration failures. In response, PYNEH Sleep Centre implemented an enhancement program for home CPAP titration to ensure satisfactory success rate, while alleviating the burden of lengthy waiting times of inpatient titration.
Objectives :
To evaluate the effectiveness of telemetric home CPAP titration in:
• Maintaining satisfactory success rate
• Shortening waiting times for inpatient titration
• Reducing clinical admissions
Methodology :
Standardized triage criteria and workflows were established for patient selection. Patients participated in an educational session about OSA and CPAP, followed by daytime CPAP trial in sleep centre. To enhance confidence in using CPAP at home, online educational videos were produced for patients’ self-access. Tele-monitoring was conducted through web cloud, along with phone consultations to track and analyze CPAP usage. Based on patient feedback and usage data, guidance was offered to manage side effects and provide troubleshooting support. Online CAP settings adjustments were made as needed. If indicated, fast-track appointments to specialist clinics and/or advanced ventilation mode titrations would be arranged.
Retrospective analysis was conducted to compare outcomes before and after home titration service enhancement. Additionally, questionnaires were distributed to evaluate patient satisfaction.
Result & Outcome :
Enhanced home titration program was implemented in May 2023, with a total of 635 titrations performed from May 2023 to Dec 2024:
• Comparable success rate of home titration (92.1%) with inpatient titration (95.7 %)
• Inpatient titration reduced by 23.4% (comparing Jan 2023 with Dec 2024)
• Waiting times for inpatient titration decreased by (comparing Jan 2023 with Dec 2024)
o 63.5% (22.8 weeks) for Priority 1
o 56% (44.6 weeks) for Priority 2
o 26.3% (25.1 weeks) for Routine
• Avoided 635 clinical admissions for inpatient titrations
• 94% of patients were satisfied with the service
Conclusions
Enhanced home CPAP titration service is effective in maintaining quality of care and shortening waiting time for patients strongly indicated for inpatient titration.
