CPAP Adherence in Low Cardiovascular Risk OSA Not Improved With Telemonitoring

Use of a multimodal telemonitoring intervention in patients with severe obstructive sleep apnea (OSA) and low cardiovascular (CV) risk does not increase adherence to treatment with continuous positive airway pressure (CPAP), according to the results of analysis published in CHEST.

Researchers conducted a prospective, multicenter, randomized, controlled trial (OPTISAS 1; ClinicalTrials.gov Identifier: NCT01796769) in France, comparing the use of the telemonitoring intervention with usual care. They sought to explore the effect of a multimodal TM intervention on CPAP adherence, quality of life, and functional status in patients with symptomatic OSA and low CV risk. Researchers theorized that patients with severe and symptomatic OSA who had low CV risk (ie, no CV comorbidities) would benefit from a multidisciplinary, coordinated follow-up based on telemonitoring, in order to attain improved adherence to CPAP treatment.

From February 2013 through October 2013, patients with suspected OSA who attended one of the participating sleep centers in France were screened for study inclusion. Patients were chosen based on their complaint of sleepiness, regardless of their Epworth Sleepiness Scale score. Eligible participants were aged 18 to 78 years and had severe OSA, which was defined as an apnea hypopnea index (AHI) of >30 events per hour, according to respiratory polygraphy or polysomnography. Study inclusion criteria were no known CV disease at baseline and a CV risk of <5%.

A total of 206 participants with OSA were enrolled in the study, of whom 102 received telemonitoring and 104 received usual care. The median patient age was 50.6 years (range, 42.1-58.1 years); 63% were men. Participants’ average body mass index was 30.6 kg/m² (range, 26.8-35.1 kg/m²) and the mean AHI was 45.2 events per hour (range, 34.0-60.0 events per hour).

Following 6 months of treatment, CPAP adherence was similar in both groups, per evaluation by either mean duration of usage (4.73±2.48 hours per night in the telemonitoring group vs 5.08±2.44 hours per night in the usual care group; P =.30) or by percentage of patients who were adherent to treatment (>4 hours of usage per night for >70% of nights: 64% in the telemonitoring group vs 72% in the usual care group; P =.24). No significant differences were reported between the groups with respect to the effect size of improvement in fatigue and sleepiness.

The investigators concluded that future research is warranted to explore whether combining telemonitoring with additional patient engagement tools will result in an increase in CPAP adherence.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Tamisier R, Treptow E, Joyeux-Faure M, et al; on behalf of the OPTISAS trial investigators. Impact of a multimodal telemonitoring intervention on CPAP adherence in symptomatic low-cardiovascular risk sleep apnea: a randomized controlled trial [published online July 5, 2020]. CHEST. doi:10.1016/j.chest.2020.05.613