Pressure adjustment is the most useful intervention for improving compliance in telemonitored patients treated with CPAP in the first 6 months of treatment

Abstract

Purpose Telemonitoring (TMg) for patients treated with continuous positive airway pressure (CPAP) is now routine care in some sleep labs. The purpose of the present study was to identify technical interventions associated with improved CPAP compliance in a real-life cohort of newly telemonitored patients with obstructive sleep apnea (OSA) during the first 6 months of treatment. Methods All patients with moderate-to-severe OSA (apnea-hypopnea index (AHI) ≥ 15/h) who were newly treated with CPAP were included in the study and telemonitored. A group educational session was scheduled after 1 month. Technical interventions were performed at the patient's request and during scheduled visits and the impact of each intervention on CPAP therapy compliance was collected. Results Between May 2018 and Dec 2019, 349 patients newly diagnosed with OSA were hospitalized in the sleep lab for CPAP titration and 212 patients were included (mean age 54.6 ± 13.1 years, mean BMI 31.7 ± 5.8 kg/m 2 , mean AHI 42.8 ± 22.0). TMg acceptance rate was 87%. Mean 6-month compliance was 275 ± 154 min, 13% stopped CPAP, and 17% were non-compliant. Correlations were observed between BMI (r = 0.15, p = 0.029), median and 95th percentile leaks (r = −0.23 and −0.18, p = 0.016 and 0.002), and CPAP compliance.During follow-up, 92 interventions were required, mainly for mask change (n = 80). Pressure modification (n = 16) was the only intervention that increased CPAP use > 30 min/night, p = 0.021. Conclusion Pressure modification was the only adaptation that significantly increased CPAP compliance during the first 6 months. Remote TMg allows providing daily, accurate, and immediate feedback that could help clinicians to confirm that the CPAP treatment is effective.

Continuous positive airway pressure treatment in sleep apnea: patient compliance and impact on the right heart

“…Furthermore, previous investigations have reported that early pressure modification enhances CPAP adherence during the first 6 months of therapy [ 20 ]. In this study, only 13% patients stopped CPAP therapy, and 17% patients were non-compliant.…”

Telemedicine and virtual respiratory care in the era of COVID-19

“…In terms of service delivery, telemonitoring has been deemed feasible in a range of healthcare systems, [105][106][107][108] facilitating access to CPAP initiation, [105] promoting timely titration of therapy, [106,109,110] and troubleshooting of technical problems. [106,111] A meta-analysis (n=11 RCTs; 1440 patients) concluded that overall telemedicine improved adherence compared to centre-based care. [112] Clinical outcomes (for example Epworth Sleepiness Score) were generally reported as similar between groups, [59,105,109,113] and there is evidence that telehealth is more cost-effective than traditional in-person follow-up.…”

Telemonitoring for the Follow-Up of Obstructive Sleep Apnea Patients Treated with CPAP: Accuracy and Impact on Therapy

“…These discrepancies highlight the fact that organization of care around CPAP therapy plays an important role in patient adherence and compliance. Indeed, close follow-up of these patients is mandatory, especially at the beginning of treatment, as 38% of patients require mask changes and 7.5% require pressure modifications in the first 6 months of telemonitored CPAP therapy [ 34 ]. There is also reason to believe that long-term follow-up should be kept in the hands of specialized professionals.…”

“…Bros et al reported the same concerns, with a majority of patients finding TMg useful but 40% considering TMg to be intrusive [ 59 ]. However, in a recent study from Carlier et al related to interventions performed in telemonitored CPAP patients during the first 6 months of treatment, acceptance (obtained via informed consent) was as high as 87% [ 34 ]. Similar data (acceptance of 78%) was also reported in another study [ 59 ].…”