Multimodal Telemonitoring for Weight Reduction in Patients With OSA and Obesity

A telemonitoring program for patients with obstructive sleep apnea (OSA) and obesity that provides patients with feedback on body weight, blood pressure, and physical activity may improve weight loss in these individuals, according to study findings published in Chest.

Among patients with OSA who use continuous positive airway pressure (CPAP), use of telemonitoring to collect data and provide patient feedback has been found to enhance CPAP adherence. Researchers sought to determine whether telemonitoring that measured and provided feedback on body weight (BW), blood pressure (BP), and physical activity could encourage weight loss in patients with OSA using CPAP.

The randomized, controlled, open-label trial was conducted at 16 sleep centers in Japan from November 2018 to December 2019 and included 168 adults (aged ≥20 years) with OSA who were regularly followed for continuous positive airway pressure (CPAP) management and had a body mass index (BMI) of at least 25 kg/m². Participants’ BMI at baseline was 31.8±4.7 kg/m² in the usual-CPAP-TM group (mean age, 56±11 years; 84.5% men) and 31.6±5.1 kg/m² in the MM-TM group (mean age, 56±11 years; 82.1% men).

Patients were randomly assigned 1:1 to receive usual CPAP telemonitoring (usual-CPAP-TM group) or multimodal-telemonitoring (MM-TM group). Patients visited the clinics every 3 months and were followed for 6 months. Attending physicians provided monthly telephone feedback in the months when participants did not visit the clinic. Physicians encouraged patients in the usual-CPAP-TM group to optimize CPAP adherence only; for the MM-TM group, physicians encouraged patients to lose weight and reminded them of the target weight goal as well as provided feedback on CPAP adherence. The primary outcome was the achievement of at least 3% BW reduction from baseline.

The percentage of patients who achieved the primary outcome was significantly increased in the MM-TM group compared with the usual-CPAP-TM group (39.3% vs 25.0%, respectively, P =.047). Both groups had a significant BW reduction from baseline to the end of the study, with the MM-TM group having a significantly greater BW reduction vs the usual-CPAP-TM group (-2.4±3.9 vs -0.8±3.2 kg, respectively, P =.007). Multivariate regression analysis demonstrated that allocation to the MM-TM group was significantly associated with BW change from baseline to study end (β = -0.21, P =.006) independent of BW at baseline.

Both groups had a significant decrease in changes in blood pressure (BP) measured at clinic visits, although there was no significant difference in changes between the 2 groups. Also, no significant differences were observed between groups in changes in the average BP measured at home.

The MM-TM group had a significantly higher percentage of days with available BW data and step count per day from baseline to study end compared with the usual-CPAP-TM group (% days with available BW data, 76.6±23.8 vs 67.7±30.2%, respectively, P =.04; number of steps, 4767 [2864-6617] vs 3592 [2117-5383]/day, P =.02).

Study limitations included large differences in CPAP duration between individuals within each of the groups and a lack of standardization in the timing of BP measurements at the clinic and at home.

“The present study shows that among OSA patients with obesity, implementation of a remote feedback program on multimodal self-monitored data can enhance BW reduction compared to feedback on CPAP adherence only,” stated the researchers.

Disclosure: Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

Reference

Murase K, Minami T, Hamada S, et al. Multimodal telemonitoring for weight reduction in sleep apnea patients: a randomized controlled trial. Chest. Published online August 20, 2022. doi:10.1016/j.chest.2022.07.032