A novel postal-based approach to diagnosing obstructive sleep apnoea in a high-risk population

- Postal sleep studies avoid hospital attendance when investigating obstructive sleep apnoea (OSA).
- This approach may be suitable for people who are geographically distant from the sleep centre.
- This can also be suitable for screening a population at high risk for OSA.
- OSA is highly prevalent in people with diabetic macular oedema.

ObjectiveMore than 50% of patients with diabetic macular oedema (DMO) have obstructive sleep apnoea (OSA), but the majority remain undiagnosed. We used a four-channel device (ApneaLink [AL], ResMed, UK) to establish a remote postal-based diagnostic service for patients with DMO. Here we describe our experience.MethodsPatients with DMO were invited to participate. Interested patients returned a free-post reply slip to the study team, who posted an AL with pictorial and written instructions to them. Following a single night study, the AL was returned by a freepost service.ResultsResponses from 733 patients meeting the inclusion criteria were received, comprising 469 males and 264 females, mean age 64 years (standard deviation 10.4 years). ALs were issued to 718 patients, of whom 606 completed a diagnostic study. A total of 71 patients (12%) required a repeat study due to inadequacy of the first attempt. Completed sleep studies showed that 75% of respondents had sleep disordered breathing: 4% ODI 0-4/h, 24%; 5-9/h, 19%; 10-19/h, 23%; ≥20/h, 34%; and AHI 0-4/h, 25%; 5-14/h, 38%; 15-29/h, 20%; ≥30/h, 17%. Among 1592 postal events through the national post service, 20 ALs were lost.ConclusionsWe have demonstrated that a remote postal-based diagnostic service for populations with a high risk of OSA can be successfully performed. This novel approach, which avoids clinic attendance, may be useful in clinical practice.