P54 The impact of a clinical decision support system in the assessment of CPAP compliance in obstructive sleep apnoea and in the identification of residual excessive daytime sleepiness. (11th November 2022)

• Record Type: Journal Article
• Authors: Chakrabarti, B; Angus, R; England, P; Osborne, M; Qureshi, T; Mir, M; Reed, L; McKnight, E; Craig, SE
• Is Part Of: Thorax. Volume 77(2022)Supplement 1
• Page Start: A111
• Page End: A111
• Publication Date: 2022-11-11
• Subjects: Chest -- Diseases -- Periodicals; Thorax; Chest -- Diseases; Periodicals; Periodicals; 617.54
• DOI: 10.1136/thorax-2022-BTSabstracts.190
• Languages: English
• ISSNs: 0040-6376

Abstract

Abstract : Background: We have previously reported on the benefits of using a clinically validated computer guided consultation system i.e. clinical decision support software (CDSS) for the assessment of patients referred with suspected Obstructive Sleep Apnoea (OSA). However, NICE guidance state the importance of formally assessing CPAP compliance following therapy initiation. We aimed to study the impact of introducing a CDSS in our pathway following CPAP initiation and its utility in identifying patient cohorts of clinical importance. Methodology: The CDSS (SleepHealth Solutions Ltd) is an NHS Framework listed digital ecosystem comprising multiple intelligent consultations encompassing the entire OSA pathway acting as an 'end to end' system solution and an Electronic Patient Record. The CPAP 'compliance' consultation takes 10 minutes, has remote capability, contains medical alerts and intelligently directs the operator to ensure that upon completion, patients enter the correct clinical pathway. Results: 1283 patients (see table 1 ) established on CPAP underwent remote review with the CDSS by paramedical staff. 419 (33%) were deemed CPAP 'compliant' (CPAP usage ≥4 hours nightly for ≥70% of nights). 5% of those deemed 'compliant' were found to have an AHI≥5 with an ESS>10 and were flagged by the software for CPAP adjustment/review. 15% of those 'deemed compliant (5% in total) were found to have residual Excessive Daytime Sleepiness (EDS; defined as CPAP 'compliant', ESS >10 & AHI<5 on CPAP) flagged by the software as requiring medical review. Prior to the introduction of the CDSS, no patients with residual EDS had been identified post CPAP initiation in the preceding 12 months (McNemar's test; p<0.001). 856 patients held a valid driving license of whom 15 (1.7%) specifically described driving related sleepiness as part of the consultation; post CPAP ESS significantly higher in this group (15 (SD 6) v 6 (SD 5)). Prior to the introduction of the CDSS, no patients specifically describing driving related sleepiness had been identified post CPAP initiation in the preceding 12 months (McNemar's test; p<0.001). Conclusions: The routine use of a CDSS post CPAP initiation ensures sleep services direct patients to the appropriate clinical pathway including early identification of those with residual EDS. Please refer to page A214 for declarations of interest related to this abstract.