A telemedicine intervention to improve adherence to continuous positive airway pressure: a randomised controlled trial

Abstract

Background Continuous positive airway pressure (CPAP) is the most widely prescribed treatment for obstructive sleep apnoea syndrome (OSAS). Although it has been shown to improve the symptoms of OSAS, many patients have difficulty adhering to this treatment. The purpose of this study was to investigate the effectiveness of an automated telemedicine intervention to improve adherence to CPAP. Methods A randomised clinical trial was undertaken in 250 patients being started on CPAP therapy for OSAS. Patients were randomly assigned to use a theory-driven interactive voice response system designed to improve CPAP adherence (telephone-linked communications for CPAP (TLC-CPAP), n¼124) or to an attention placebo control (n¼126) for 12 months. TLC-CPAP monitors patients' self-reported behaviour and CPAP-related symptoms and provides feedback and counselling through a structured dialogue to enhance motivation to use CPAP. A Sleep Symptoms Checklist, the Functional Outcomes of Sleep Questionnaire, the Center for Epidemiological Studies Depression Scale and the Psychomotor Vigilance Task were administered at study entry and at 6-month and 12-month follow-up. Hours of CPAP usage at effective mask pressure were measured by the CPAP device stored in its memory and retrieved at each visit. Results Median observed CPAP use in patients randomised to TLC-CPAP was approximately 1 h/night higher than in the control subjects at 6 months and 2 h/night higher at 12 months. Using generalised estimating equation modelling, the intervention had a significant effect on CPAP adherence. For secondary analysis, the effect of CPAP adherence on the secondary outcomes was analysed. CPAP adherence was significantly associated with a greater reduction in sleep apnoea symptoms and depressive symptoms and a greater improvement in functional status. No significant association was observed between CPAP adherence and reaction time. Conclusions The TLC-CPAP intervention resulted in improved CPAP adherence, which was associated with improved functional status and fewer depressive symptoms. Clinical trial.gov: NCT00232544.

Intensiveversusstandard follow-up to improve continuous positive airway pressure compliance

“…In a study by FALCONE et al [48] in which 206 patients were randomised into two groups, patients in the educational support group, who had the opportunity to review their own PSG charts before and after CPAP, showed better adherence after 12 months of therapy. Another randomised clinical trial showed enhanced CPAP use in a small sample of participants who received a 12-month telemedicine intervention [50]. The current study overcame specific limitations of previous CPAP adherence intervention studies by: recruiting an adequate sample size of Greek patients, a typical Mediterranean population; allocating patients randomly to the intervention arms; and assessing adherence outcomes up to 24 months follow-up, a significantly longer time period than in many of the previous studies in this region.…”

“…There are only limited data from long-term randomised clinical trials evaluating an intensive follow-up programme aimed at improving CPAP compliance [47][48][49][50][51][52]. Three studies found no significant difference between intensive and standard care alone regarding compliance with CPAP treatment or quality of life [47,49,52].…”

Treatment of Obstructive Sleep Apnea Syndrome with Nasal Positive Airway Pressure Improves Golf Performance

“…The effectiveness of these and other interventions are widely debated throughout the recent sleep literature. [21][22][23][24][25] Most of the newer PAP devices incorporate sophisticated compliance and efficacyreporting software, with detailed reports routinely available at the time of office visits as well as via real-time wireless transmission. Some practitioners have developed and implemented comprehensive compliance-enhancement programs with encouraging results.…”

The Past Is Prologue: The Future of Sleep Medicine

“…41 For these reasons telemedicine increases PAP treatment adherence with benefits to patient outcomes. [42][43][44] This is particularly important considering that the Centers for Medicare and Medicaid Services is shifting from a fee-for-service payment model toward a performance payment model as stipulated in the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which established the Merit-Based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs). Although important questions regarding the long-term effect of telemedicine remain, 45 by improving patient access and convenience, and increasing practice efficacy, telemedicine can help address the sleep specialist workforce shortage and promote positive health outcomes by expanding the reach of sleep medicine practices.…”