Comprehensive management of obstructive sleep apnea by telemedicine: Clinical improvement and cost-effectiveness of a Virtual Sleep Unit. A randomized controlled trial

PLoS One. 2019 Oct 24;14(10):e0224069. doi: 10.1371/journal.pone.0224069. eCollection 2019.


Introduction: Obstructive sleep apnea (OSA) is a prevalent disease associated with significant morbidity and high healthcare costs. Information and communication technology could offer cost-effective management options.

Objectives: To evaluate an out-of-hospital Virtual Sleep Unit (VSU) based on telemedicine to manage all patients with suspected OSA, including those with and without continuous positive airway pressure (CPAP) therapy.

Methods: This was an open randomized controlled trial. Patients with suspected OSA were randomized to hospital routine (HR) or VSU groups to compare the clinical improvement and cost-effectiveness in a non-inferiority analysis. Improvement was assessed by changes in the Quebec Sleep Questionnaire (QSQ), EuroQol (EQ-5D and EQ-VAS), and Epworth Sleepiness Scale (ESS). The follow-up was 3 months. Cost-effectiveness was assessed by a Bayesian analysis based on quality-adjusted life-years (QALYs).

Results: The HR group (n: 92; 78% OSA, 57% CPAP) compared with the VSU group (n: 94; 83% OSA, 43% CPAP) showed: CPAP compliance was similar in both groups, the QSQ social interactions domain improved significantly more in the HR group whereas the EQ-VAS improved more in the VSU group. Total and OSA-related costs were lower in the VSU group than the HR. The Bayesian cost-effectiveness analysis showed that VSU was cost-effective for a wide range of willingness to pay for QALYs.

Conclusions: The VSU offered a cost-effective means of improving QALYs than HR. However, the assessment of its clinical improvement was influenced by the choice of the questionnaire; hence, additional measurements of clinical improvement are needed. Our findings indicate that VSU could help with the management of many patients, irrespective of CPAP use.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Bayes Theorem
  • Continuous Positive Airway Pressure / methods*
  • Cost-Benefit Analysis*
  • Disease Management
  • Female
  • Humans
  • Male
  • Middle Aged
  • Patient Compliance / statistics & numerical data*
  • Quality of Life*
  • Sleep Apnea, Obstructive / economics*
  • Sleep Apnea, Obstructive / therapy*
  • Surveys and Questionnaires
  • Telemedicine / methods*

Grant support

The Spanish Ministry of Economy and Competitiveness (PI14/00416 and PI17/01068, and the Catalan Society of Pneumology (SOCAP, funded this study. JMM received the funds. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. It has also been included in the manuscript.