Abstract Introduction Obstructive sleep apnea (OSA) is associated with increased cardiovascular morbidity and mortality. Standard management typically involves in-person diagnosis, PAP initiation, and follow-up, but many older adults experience fragmented care due to mobility limitations, comorbidities, or transportation barriers. Telemedicine offers an alternative model that may improve continuity, access, and patient engagement. This case describes five years of virtual OSA management in an older adult with changing medical needs. Report of case(s) An 82-year-old man with atrial fibrillation/flutter (status post multiple ablations and cardioversions), gastroesophageal reflux disease, hyperlipidemia, OSA, and insomnia was followed entirely through telemedicine. Home sleep apnea testing (HSAT) in 2020 revealed mild OSA (REI 12/hour, nadir SpO₂ 79%, 74 minutes 88%). The patient declined CPAP and chose a mandibular advancement device (MAD). Telemedicine visits from 2020–2022 documented high adherence, symptom improvement, and reduced REI with the MAD. Repeat HSAT showed persistent hypoxemia not explained by residual apneas, prompting in-lab polysomnography (PSG). PSG with the MAD demonstrated REI ~9/hour without significant hypoxemia, supporting continued MAD therapy. Following influenza A pneumonia requiring ICU admission in 2023–2024, the patient experienced functional decline, recurrent atrial fibrillation, 26-lb weight loss, and new oxygen dependence. Because untreated OSA can exacerbate arrhythmia recurrence, repeat evaluation was pursued. In 2025, PSG with the MAD showed progression to severe OSA (REI 32.9/hour, nadir SpO₂ 83%, 24 minutes 88%). A titration PSG was scheduled to assess supplemental alternative therapies. Conclusion This case illustrates how telehealth can support long-term OSA management in medically complex patients. Virtual care enabled timely reassessment, coordination with dental sleep medicine, and rapid adjustments during periods of clinical instability. Telemedicine was particularly useful for this elderly patient, who faced mobility challenges, hospitalizations, and comorbidities that made in-person visits difficult. Regular virtual follow-up promoted adherence, facilitated recognition of disease progression, and allowed treatment to be individualized over time. Telemedicine represents an effective model for continuous, patient-centered OSA care, especially for older adults and individuals with limited access to traditional sleep medicine services. This case highlights the value of virtual care in maintaining continuity, supporting multidisciplinary collaboration, and adapting therapy to evolving clinical needs. Support (if any)
Seifert et al. (Fri,) studied this question.