| Objectives1. To perform a clinical observation on home-based non-invasive positive pressure ventilation (NIPPV) using TELETREK remote monitoring system, assess the efficacy of NIPPV as well as compliance rate, and investigate the influencing factors to the compliance in children with risk factor-associated obstructive sleep apnea-hypopnea syndrome (OSAHS).2. To investigate whether the internet-based remote monitoring system could provide a practical and safe clinical mode for children with risk factor-associated OSAHS who require long-term home-based NIPPV therapy through comparing the cost and duration of TELETREK remote monitoring system with traditional follow-up visits and conducting a questionnaire survey on children's parents and doctors for overall evaluation of TELETREK system.MethodsNineteen patients with risk factor-associated OSAHS requiring home-based NIPPV therapy were admitted to otolaryngopharyngology department of Guangzhou Children's Hospital from March 2009 to April 2011. During hospitalization, a 3-day polysomnography monitoring, pressure titration and adaptive treatment course was conducted, and training on how to operate the ventilator was performed in parents prior to children's discharge. After discharge, clinical observation and intervention strategies were performed according to the ventilator's parameters (mean therapeutic pressure, mean oxygen saturation, respiratory rate, heart rate, mean daily treatment time, mean leakage rate, etc.) using TELETREK. Questionnaire surveys were also conducted on regular schedule basis in children's family members as well as the attending doctors to investigate the performance of TELETREK, and preliminary analysis and assessment were performed through comparing the cost and treatment duration of TELETREK system with traditional follow-up visits.Results1.Eight children received long-term home-based NIPPV treatment successfully, with 3 children underwent withdrawal and the rest children remain in treatment. Significant improvement was observed in sleep disorder-associated symptoms, and growth and development-related clinical parameters were restored to overall normal levels after treatment.2.According to the analysis on TELETREK system on the compliance of home-based NIPPV therapy, 19 children received the treatment successfully. Seven children dropped out during the early stages (within a week), with the main reasons of treatment intolerance (6/7) and economic factors (1/7). Four children dropped out after 1 month, with the main reasons of economic factors (2/4) and parents'subjective factors (2/4). High compliance was noticed in eight children who successfully underwent NIPPV treatment. However, fluctuations in the compliance persisted in both the early stage and a period after initiation of treatment.3.The days with timely uploading transmission of data from TELETREK system accounted for 93% of the total days, no systemic or technical error was reported. Easy for use and convenience for operating were regarded by over 80% of children's parents and attending doctors, who expressed satisfaction to TELETREK system. The average distance and commuting time to the hospital were 113±71 km (range: 10–350 km) and 199±151 min (range 50–870 min), respectively. Compared with hospital follow-up visits (371±182 min (range 115–710min), less time (P< 0.05) was required in transmission of data (5.7±3.1 min, range: 2.5–19.1 min). To date, the average individual cost was $632, with a reduction of $924 (59.4%) compared with the traditional follow-up visit ($1556).Conclusions1.Home-based NIPPV therapy is effective in treating children with risk factor-associated OSAHS.2. TELETREK system surveillance on compliance of long-term home-based NIPPV therapy revealed a high discontinuation rate during early stages of treatment, with main reasons of treatment intolerance. High compliance is revealed in children received long-term treatment, with fluctuations persisted.3. Due to high acceptance in patients and doctors, the system can provide an effective, practical, and safe clinical mode for infants and children with OSAHS who receive long-term home-based NIPPV treatment. |
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