Effectiveness of Electronic Health Interventions in Improving Treatment Adherence for Adults With Obstructive Sleep Apnea: Meta-Analytic Review

Abstract

Background Poor adherence to continuous positive airway pressure (CPAP) treatment by adults with obstructive sleep apnea (OSA) is a common issue. Strategies delivered by means of information and communication technologies (ie, electronic health [eHealth]) can address treatment adherence through patient education, real-time monitoring of apnea symptoms and CPAP adherence in daily life, self-management, and early identification and subsequent intervention when device or treatment problems arise. However, the effectiveness of available eHealth technologies in improving CPAP adherence has not yet been systematically studied. Objective This meta-analytic review was designed to investigate the effectiveness of a broad range of eHealth interventions in improving CPAP treatment adherence. Methods We conducted a systematic literature search of the databases of Cochrane Library, PsycINFO, PubMed, and Embase to identify relevant randomized controlled trials in adult OSA populations. The risk of bias in included studies was examined using seven items of the Cochrane Collaboration risk-of-bias tool. The meta-analysis was conducted with comprehensive meta-analysis software that computed differences in mean postintervention adherence (MD), which was defined as the average number of nightly hours of CPAP use. Results The meta-analysis ultimately included 18 studies (N=5429 adults with OSA) comprising 22 comparisons between experimental and control conditions. Postintervention data were assessed at 1 to 6 months after baseline, depending on the length of the experimental intervention. eHealth interventions increased the average nightly use of CPAP in hours as compared with care as usual (MD=0.54, 95% CI 0.29-0.79). Subgroup analyses did not reveal significant differences in effects between studies that used eHealth as an add-on or as a replacement to care as usual (P=.95), between studies that assessed stand-alone eHealth and blended strategies combining eHealth with face-to-face care (P=.23), or between studies of fully automated interventions and guided eHealth interventions (P=.83). Evidence for the long-term follow-up effectiveness of eHealth adherence interventions remains undecided owing to a scarcity of available studies and their mixed results. Conclusions eHealth interventions for adults with OSA can improve adherence to CPAP in the initial months after the start of treatment, increasing the mean nightly duration of use by about half an hour. Uncertainty still exists regarding the timing, duration, intensity, and specific types of eHealth interventions that could be most effectively implemented by health care providers.

The impact of the involvement of a healthcare professional on the usage of an eHealth platform: a retrospective observational COPD study

“…In pulmonology, an improvement of the subscale CCQ symptom score was found after participating in an eHealth platform for a prospective COPD study in a blended care setting [ 20 ]. In a meta-analysis about the effectiveness of eHealth intervention in Obstructive Sleep Apnea (OSAS) no difference was found between studies using eHealth as an add-on to care as usual and studies using eHealth as a replacement of care as usual [ 21 ]. The nightly use of CPAP (adherence) increased, with eHealth interventions compared to care as usual, regardless of the involvement of a healthcare professional.…”

Telemedicine in Sleep-Disordered Breathing

“…Some study results suggest that the use of telemonitored CPAP compliance and efficacy data seems to be as good as standard care in its effect on compliance rates and outcomes in new CPAP users, although conflicting data remain. 10,96,97 However, the results from other RCTs regarding improvement in compliance are disappointing (Table 3), given many studies do not show any improvement in compliance with telemonitoring. In contrast, in some of these studies, despite the application of telemonitoring, compliance remained extremely low, questioning the level of usual care in these centers.…”

Patient's treatment burden related to care coordination in the field of respiratory diseases

“…In the past few years, a big step forward has been made with the introduction of telemonitoring and technological strategies that allow remote assistance and provide a supporting network among patients and all involved professionals [60]. Indeed, recent studies have showed the effectiveness of telehealth in improving access to care and patient's outcomes [61][62][63].…”