Even after long-term continuous positive airway pressure (CPAP) use, intensive telemedicine support can be used to help optimize CPAP adherence in patients with obstructive sleep apnea (OSA), according to study results published in Annals of the American Thoracic Society.
This multicenter, prospective, randomized, non-inferiority trial (UMIN Clinical Trials Registry Number: UMIN000023118) conducted in 17 Japanese sleep centers was designed to investigate the effects of telemedicine intervention on treatment adherence in long-term CPAP users (≥3 months). Participants were randomly assigned to 1 of 3 groups: (1) telemedicine group, with follow-up every 3 months and a monthly telemedicine intervention, (2) 3-month group, with follow-up every 3 months, and (3) 1-month group, with monthly follow-up. Each of these groups was followed up for 6 months. The change from baseline in the percentage of days with at least 4 hours per night of CPAP use was evaluated at the end of the study period.
Participants were categorized according to change in adherence: ≤-5%=deterioration of adherence, > -5 to <5%=no change in adherence, and ≥5%=improvement in adherence. The primary study outcome was the number of participants with deterioration of adherence. The Farrington-Manning test (noninferiority margin, 15%) was used to compare the non-inferiority of the telemedicine and 3-month groups with the 1-month group, according to the number of participants with deterioration of adherence.
In the telemedicine group, 25.5% of participants showed deterioration of adherence, compared with 33.1% in the 3-month group and 22.4% in the 1-month group. The telemedicine group was noninferior to the 1-month group in the percentage of patients with deterioration in adherence (3.0%; 95% CI, -4.8% to 10.9%; P <.01), whereas the 3-month group did not show noninferiority (10.7%; 95% CI, 2.6%-18.8%; P =.19). The percentage of days with 4 or more hours per night of CPAP use increased slightly but statistically significantly in the telemedicine and 1-month groups (telemedicine-group: 76.6%±24.2% to 79.5%±22.0%, P <.01; 1-month group: 76.2%±24.9% to 78.4%±22.8%, P =.03) but remained unchanged in the 3-month group (75.6%±26.8% to 74.4%±27.5%, P =.24), although CPAP usage time did not significantly change in any of the groups (telemedicine group: 322±97 to 327±91 min/night, P =.30; 3-month group: 313±102 to 307±107 min/night, P =.09; 1-month group: 323±99 to 328±92 min/night, P =.16)
Among participants with poor adherence at baseline (<70% days with ≥4 h/night of CPAP use), both the percentage of CPAP use and usage time significantly increased in the telemedicine group and the 1-month group (percentage of days with ≥4 h/night of CPAP use: telemedicine group, 45.8%±18.2% to 57.3%±24.4%, P <.01; 1-month group, 43.1%±18.5% to 53.6%±24.3%, P <.01; usage time: telemedicine group, 214±68 min/night to 239±79, min/night P <.01; 1-month group, 203±63 min/night to 235±79 min/night, P <.01), but not in the 3-month group (39.3%±20.8% to 39.8%±24.8%, P =.84 and 188±76 min/night to 180±87 min/night, P =.36 ).
The main limitation of this study was generalizability. Nonetheless, the study investigators concluded, “Even after long-term CPAP use, the intensive supportive intervention helped to improve adherence in patients with poor adherence. Further, implementation of the telemedicine intervention may reduce the medical cost of CPAP treatment management.”
Murase K, Tanizawa K, Minami T, et al. A randomized controlled trial of telemedicine for long-term sleep apnea CPAP management [published online November 5, 2019]. Ann Am Thorac Soc. doi:10.1513/AnnalsATS.201907-494OC