Documented Home Apnea Monitoring: Effect on Compliance,Duration of Monitoring,and Validation of Alarm Reporting

Abstract

The objectives of this study were to: (1) measure patient compliance with monitoring, (2) validate parental reports of alarms at home, (3) examine monitoring duration, and (4) compare documented monitor records with the traditional pneumogram to evaluate patients for monitor discontinuation. During the 1-year period fromJanuary through December, 1992, 114 infants were followed up with documented monitoring. Simultaneously, 113 infants were followed up with conventional monitors. Infants were premature, or victims of apparent life-threatening episodes (ALTE), or siblings of SIDS victims. Monitors recorded all episodes of apnea greater than 15 seconds and bradycardia loss than 80 beats per minute. All families were contacted biweekly by telephone. Downloads were performed at regular intervals. Monitor downloads were compared with simultaneous pneumograms to assess the accuracy of a long-term, intermittent event-recording system versus short-term (6-to 12-hour) continuous recording. All families were highly compliant with the use of home monitoring. Although Caucasian families used the monitors more often than non-Caucasian families, all groups used the monitor >75% of the time. True episodes were verified in 38% of patients by monitor downloads. Only 7.4% of all recorded events were true events. Of the real events, 51.2% were apneas of 16-20 seconds. No significant differences were found in overall duration of monitoring between documented and nondocumented monitors. In the premature infants, the duration of monitoring was significantly reduced in those infants found to have no true episodes over those with real events at home. Readmission for ALTE was reduced in infants with documented monitors. Premature infants without events were monitored an average of 24 fewer days (P=0.03). Computerized monitor downloads were found to be equally, if not more, sensitive than pneumograms in evaluating infants for monitor discontinuation. Documented monitoring offers a viable alternative to traditional monitoring and pneumograms in assisting clinicians and families in evaluating their infant's progress. By accurately assessing compliance, distinguishing true from false alarms, and decreasing the need for pneumograms, these devices provide valuable information to clinicians and families.

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References

1. Blake AM , Langham J , Collins LM , et al. Clinical significance of apnoea alarm mattress for newborn infants. Lancet. 1970;2:183-185.

2. Neuman MR . Apnea monitoring: technical aspects. In Little GA , ed. Infantile Apnea and Home Monitoring: Report of a Consensus Development Conference Bethesda, MD: NIH (NIH 87-2905); 1987:4-1 to 4-67.

3. Hodgeman JE , Hoppenbrowers T . Home monitoring for sudden infant death syndrome: the case against. Ann NYAcad Sci. 1988;164:533-542.

4. Brouillette RT , Morrow AS , Weese-Mayer DE , et al. Comparison of respiratory inductive plethysmography and thoracic impedance for apnea monitoring. JPediatrics. 1987;111:377-381.

5. Ahmann E , Wulff L , Meny RG . Home apnea monitoring and disruptions in family life: a multidimensional controlled study Am J Public Health. 1992;82:719-722.

6. Black L , Steinschneider A . Impact of the apnea monitor on family life. Pediatrics. 1978;62:681-685.

7. Cain LP , Kelly DH , Shannon DC . Parents' perception of the psychological and social impact of home monitoring. Pediatrics. 1980;66:37-41.

8. Nuttall P . Maternal responses to home apnea monitoring of infants. Nurs Research. 1988;37:354-357.

9. Wilson AL , Stevens DC , Becker BK , et al. Mothers' behavior with home infant apnea monitors. J Perinatology. 1990;10:275-279.

10.

10. Gilmore A . Apnea maonitors of little use in preventing SIDS, experts say. Can Med Assoc J. 1989;140(9):1072-1076.

11.

11. Krongrad E , O'Neill L . Near miss sudden infant death syndrome episodes? A clinical and electrocardiographic correlation. Pediatrics. 1986;77:811-815.

12.

12. Rosen CL , Frost JD , Harrison GM . Infant apnea: polygraphic studies and follow up monitoring. Pediatrics. 1983;71:731-736.

13.

13. Davidson-Ward SL , Keens TG , Chan LS , et al. Sudden infant death syndrome in infants evaluated by apnea programs in California. Pediatrics. 1986;77:451-455.

14.

14. Weese-Mayer DE , Brouillette RT , Morrow AS , et al. Assessing the validity of infant monitor alarms with event recording. J Pediatrics. 1989;115:702-708.

15.

15. Weese-Mayer DE , Morrow , Conway LP , et al. Assessing the clinical significance of apnea exceeding 15 seconds with event recording. J Pediatrics. 1990;117:568-572.

16.

16. Spitzer AR , Fox WW . Infant Apnea. Pediatr Clin North Am. 1986;33:561-580.

17.

17. Spitzer AR , Gibson E . Home monitoring. Clinics in Perinatology. 1992;19:907-925.

18.

18. Ahmann E , Meny RG , Fink RJ . Use of home apnea monitors. Obstet Gynecol Neo Nurs. 1992;21:394-399.

19.

19. Gordis L . Conceptual and methodologic problems in measuring patient compliance. In: Haynes RB , Taylor DW , Sackett DL , eds. Compliance in Health Care. Baltimore MD: Johns Hopkins University Press. 1979:43-45.

20.

20. Kruse W , Koch-Gwinner P , Nikolaus T , et al. Measurement of drug compliance by continuous electronic monitoring: a pilot study in elderly patients discharged from the hospital. J Am Geriatric Soc. 1992;40:1151-1155.

21.

21. Donovan JL , Blake DR . Patient noncompliance: deviance or reasoned decision making? Social Science Med. 1992;34:507-513.

22.

22. Nathanson I , O'Donnell J , Commins MF . Cardiorespiratory patterns during alarms in infants using apnea/ bradycardia alarms. Am J Dis Child. 1989;143:476-480.

23.

23. Smith Y , Hoy DA , Owens MR , Layne LC . Cost-effectiveness of early hospital discharge of premature infants with safe, short-term, home monitoring. Pediatric Res. 1992;31:261A-261A.

24.

24. Steinschneider A , Santos V . Parental reports of apnea and bradycardia: temporal characteristics and accuracy. Pediatrics. 1991;88:1100-1104.

25.

25. Meny RG , Carroll JL , Carbone MT , Kelly DH . Cardiorespiratory recordings from infants dying suddenly and unexpectedly at home. Pediatrics. 1994;93:44-49.