Beneficial Effects of Early Intervention Telemedicine-based Follow-Up in Sleep Apnea: A Randomized Controlled Multicenter Trial.

Rationale: Positive airway pressure (PAP) is standard treatment for obstructive sleep apnea. Telemedicine has been introduced for improved PAP follow-up. Objectives: Our study aim was to evaluate the clinical utility of and patient satisfaction with PAP follow-up with an early intervention telemedical protocol. Methods: A randomized controlled trial was conducted at four sleep clinics of the same county. Treatment-naive patients with obstructive sleep apnea were randomized to standard PAP follow-up (203 patients, fixed follow-up procedures) or early intervention telemedical follow-up (AirView, ResMed; 206 patients, continuous follow-up) for 3 months. Evaluated variables included PAP adherence at 3 months, patient-reported outcome measures (Epworth Sleepiness Scale, 36-item Short Form Health Survey, Insomnia Severity Index, Hospital Anxiety and Depression Scale), and staff time. Group differences were analyzed with linear mixed regression models adjusted for age, body mass index, apnea-hypopnea index, and study center. Results: The study groups were comparable at baseline (N = 409; mean age, 59 ± 12 yr; body mass index, 31.9 ± 6 kg/m2, apnea-hypopnea index, 41.5 ± 21 events/h). PAP adherence was higher in the proactive telemedicine group than in the control group (4.3 ± 2.4 and 4.1 ± 2.6 h/night; P = 0.01, respectively), and mean mask pressure at follow-up was significantly lower in the telemedicine group than in the control group (8.7 ± 2.1 cm H2O vs. 9.2 ± 2.5 cm H2O; P = 0.028). In post hoc analysis, the difference in PAP adherence between groups was most pronounced in patients with depression (4.8 ± 2.6 h/night vs. 2.7 ± 2.3 h/night; P = 0.03). Relevant mask leakage (>24 L/min) was lower in the telemedicine group (5.4% vs. 12.1%, P = 0.024). Improvement of patient-reported outcome measures and patient satisfaction was equivalent between groups. Conclusions: Proactive telemedical management of the initial follow-up of PAP treatment compared favorably with conventional follow-up in terms of adherence, pressure level, and mask leakage. Patients with depression may particularly benefit from telemedical follow-up. Specific clinical routines are required to establish this practice in sleep clinics. Clinical trial registered with www.clinicaltrials.gov (NCT03446560).

[Treatment of hepatitis C with peginterferon and ribavirin in Iceland from 2002-2012].

BACKGROUND/AIMS: Hepatitis C is a major cause of chronic liver disease and cirrhosis in Western countries. Its treatment aims at eradicating the virus and patients are considered cured if the virus is undetectable by PCR in blood 12-24 weeks after end of treatment (sustained virological response, SVR). The aim of this study is to investigate the results of treating hepatitis C in Iceland during the period 2002-2012. MATERIALS AND METHODS: Retrospective study including all patients with hepatitis C receiving treatment with peginterferone and ribavirin at Landspitali University hospital during the period 2002-2012. Patients who had been treated previously were excluded. Information was obtained from medical records and the hospital pharmacy. RESULTS: A total of 207 patients were included, 136 (66%) males and 71 (34%) females. Mean age was 38 years (range 17-66). Genotyping revealed that 71 (34%) patients had genotype 1, 135 (65%) genotype 3 and one genotype 2. A total of 147 (71%) patients achieved SVR. The rate of SVR was 77.8% for genotype 3 and 57.7% for genotype 1. 9 patients (4%) had cirrhosis and 3 of them had SVR. Of 161 patients who finished treatment per protocol, 87.5% and 77.1% with genotypes 3 and 1 respectively had SVR. CONCLUSIONS: The study demonstrates higher rates of SVR in clinical practice in Iceland compared to controlled clinical trials. The improved effectiveness may be explained by younger patient population, low rate of cirrhosis and close follow-up of patients. Key words: Hepatitis C, peg-interferon, sustained virological response. Correspondence: Sigurdur Olafsson, sigurdol@landspitali.is.