Telehome monitoring (THM) in COPD: A new model of evaluating nocturnal oxygen desaturation

The efficiency of THM of patients discharged after acute exacerbation of COPD (AECOPD) is still being investigated. It is important to recognise nocturnal desaturation in COPD to prescribe nocturnal oxygen therapy or noninvasive mechanical ventilation. Aim: The study tested the feasibility of a model of THM to determine the proportion of nocturnal oxygen desaturators without daytime hypoxemia discharged after AECOPD. Methods: We included severe COPD patients without daytime hypoxemia at blood gas analysis measured the day before discharge. Within 3 weeks after discharge patients received THM device which acquires signals from an internal pulseoximeter and connects to modem by bluetooth technology. In a web-page data are accessed. Nocturnal saturation was monitored on 5 consecutive nights and mean time spent with saturation Results: We noted in 21 COPD patients (mean FEV1: 44% predicted) an excellent reliability among the 5 oximetries with little intrapatient variability for TB90%. Desaturation and periods of nocturnal hypoventilation during spontaneous breathing were easily detected. A total of 7 (33%; ) met our criterion for nocturnal desaturators without evidence of sleep apnea. One patient was classified as desaturator with evidence of sleep apnea. Conclusions: A significant proportion (33%) of COPD patients not qualified for home oxygen therapy after hospital discharge had nocturnal oxygen desaturation without evidence of sleep apnea. THM is an effective practical method for screening this population. Supported by Fondazione Cassa di Risparmio di Carrara.