Depression and Sleep Disorders

The telemonitoring of Depression and Sleep disorders aims to promote the continuous monitoring of patients in order to improve their quality of life and obtain health gains, using a patient-centered approach and the establishment of partnerships with community institutions.

Sleep disorders can manifest in different ways, including insomnia, sleep-disordered breathing and hypersomnia, among others.

Insomnia is the most frequent sleep disorder and is characterized by difficulties in falling asleep and/or waking up earlier than usual, resulting in a feeling of non-restorative or insufficient sleep and causing dysfunctionality, often described as daytime fatigue.

The clinical evaluation of sleep disorders is done by applying specific questionnaires and polysomnographic and actigraphic diagnostic methods.
Sleep disorders have a bidirectional relationship with mental disorders, namely anxiety and depression.

Depression is a psychiatric disorder characterized by the gradual onset of feelings of persistent sadness and loss of pleasure in activities previously considered enjoyable. These symptoms are usually accompanied by other findings, namely feelings of worthlessness, irritability, apathy, hopelessness, tiredness, difficulty concentrating, loss of libido, decreased appetite, changes in sleep patterns and suicidal thoughts.

For both sleep and depressive disorders, the monitored parameters will make it possible to assess:

sleep-wake cycles
activity of the sympathetic axis of the autonomic nervous system
blood pressure heart rate
blood pressure
heart rate
analytical data including thyroid profile and benzodiazepine blood tests

According to Sociedade Portuguesa de Psiquiatria e Saúde Mental (SPPSM), it is estimated that in Portugal:

Insomnia is the most common sleep disorder in Portugal, with a prevalence of

25%

Over a fifth of the Portuguese population suffers from a psychiatric disorder

22,9%

Depression is considered the leading cause of

disability

Depression is the second cause of

loss of healthy

Objectives

Raise the quality of health services provided to citizens, making them feel continuously accompanied in their disease
Reduce the use of Health Services through the timely detection of acute symptoms, in order to prevent hospital admissions, with a consequent reduction in costs and improvement in the prognosis of patients
To proactively and continuously follow the fluctuations of each patient's condition, allowing a constant follow-up and a timely reaction, postponing as much as possible the worsening of the syndrome

Contribute to Proximity Health, guaranteeing easy access between the patient and the health care provider
Improving quality of life, with an impact on both patients and carers
Contribute to Health Literacy, particularly in the aged population, promoting the active role of the citizen/patient in the management of his/her disease

Results

Economics

Social

Clinicians

Metodology

1. Patient signalling

In Hospital or PHC and clinical and social assessment by multidisciplinary team (medical team and nursing team) confirmation of compliance with inclusion criteria

2. Patient Integration

In the telemonitoring programme by giving informed consent

3. Training/training the patient and carer in the necessary procedures

Telemonitoring and configuration of equipment for remote monitoring, i.e. measuring vital parameters and communicating them to the clinical teams

4. Parameterisation of limit values based on each patient's profile

Individual intervention algorithms, example of alerts to be considered oximetry, axillary temperature, blood pressure (this definition will be left to the medical team's discretion)

5. Initiation of the procedure for remote patient monitoring

From home (usually operated by the carer) by default, daily measurements of biometric signals take place and data is recorded electronically (e.g. mobile phone via Bitalino)

6. Alert signals, via the Desktop application

hrough the desktopapplication, existing in the Hospital, based on the data recorded by the patient/caregiver from home, alert signals are identified by the monitoring central of the installed platform, allowing immediate action by the dedicated team (first line nursing team, with medical support if necessary).

a. Telephone contact with patient/caregiver for any corrections to patient treatment or monitoring failures

b. Priority referral of the patient, via notification, for external consultation or emergency consultation, in cases where necessary

c. If it occurs, the electronic prescription avoids the need for the patient to go to the hospital in cases of medication review