Telemonitoring and individualized automated reminders may help patients with obstructive sleep apnea (OSA) adhere to their recommended continuous positive airway pressure (CPAP) use, according to a study published in the American Journal of Respiratory and Critical Care Medicine.
“With this study, we explored potentially cost-effective strategies for improving CPAP use, given the well-known challenges with optimizing CPAP adherence,” said lead author Dennis Hwang, MD, pulmonologist and sleep expert, Kaiser Permanente Fontana [California] Medical Center, Fontana, CA. “Automated telemedicine strategies may improve patient engagement and reduce the need for labor-intensive, and costly, follow-up care.”
Dr. Hwang and colleagues conducted this 4-arm, randomized, factorial-design clinical trial in 1,455 patients referred for suspected OSA (mean age: 49.1 years; 51% women). In all, 956 subjects underwent home sleep apnea testing, and 556 were prescribed CPAP.
For the study, two telemedicine interventions were used, the first a web-based OSA education (Tel-Ed) program, and the second, CPAP telemonitoring with automated patient feedback (Tel-TM). Researchers randomized patients to usual care, Tel-Ed added, Tel-TM added, or Tel-Ed and Tel-TM added (Tel-Both).
Telemonitoring patient CPAP usage was possible because the devices used for the study had the capability to record patient use and wirelessly transmit these data to a software program, which then generated customized messages. The primary endpoint of the study was 90-day CPAP usage, and secondary endpoints included OSA evaluation attendance and change in Epworth Sleepiness Scale score.
At 90 days, the average daily CPAP use was 3.8 hours in the usual care group, 4.0 hours in the Tel-Ed group, 4.4 hours in the Tel-TM group, and 4.8 hours in the Tel-Both group. Compared with usual care, CPAP usage was significantly higher in Tel-TM and Tel-Both groups 4 (P=0.0002 for both), but not for those in the Tel-Ed group (P=0.07).
The addition of telemedicine education also served to improve clinic attendance compared with no education (68.5% show rate vs 62.7%, respectively; P=0.02).
Dr. Hwang and colleagues concluded that in patients with OSA, CPAP telemonitoring with automated feedback messaging may improve 90-day adherence, and while the addition of a telemedicine-based education program did not improve CPAP adherence, it did increase clinic attendance for OSA evaluation.
“We learned that both education and accountability strategies improve patient engagement, although in different ways,” Dr. Hwang said. “We also learned that while patient education is important, it appears that accountability via telemonitoring is more effective at improving therapy adherence.”
This study was supported by a grant from the American Sleep Medicine Foundation. ResMed supported the study by providing use of the U-Sleep automated feedback platform.