Telemonitoring and automated messages improve CPAP adherence

September 12, 2017

Sept. 12, 2017--Patients with obstructive sleep apnea (OSA) are more likely to use CPAP, or continuous positive airway pressure, when their use is telemonitored and they receive individualized, automated messages that reinforce therapy adherence, according to a randomized, controlled trial published in the American Journal of Respiratory and Critical Care Medicine.

In "Effect of Telemedicine Education and Telemonitoring on CPAP Adherence: The Tele-OSA Randomized Trial," researchers report that after 90 days, those in the telemonitoring arms of the trial used CPAP 36 to 60 minutes longer each night.

"With this study, we explored potentially cost-effective strategies for improving CPAP use, given the well-known challenges with optimizing CPAP adherence," said lead study author Dennis Hwang, MD, a pulmonologist and sleep expert at the Kaiser Permanente Fontana [California] Medical Center in Fontana. "Automated telemedicine strategies may improve patient engagement and reduce the need for labor-intensive, and costly, follow-up care."

CPAP is considered the "gold standard" for OSA treatment, but many patients do not use the therapy long enough each night to gain health benefits. In this study, telemonitoring was possible because the CPAP devices recorded usage and transmitted the data wirelessly to a software program that generated the customized messages.

Telemonitoring also improved the rate at which patients achieved Medicare's CPAP adherence goals of CPAP use for four hours or more per night on 70 percent or more nights during a 30-day period in the first three months of use. Medicare adherence was 22 to 37 percent higher in the telemonitoring arms of the study.

The study enrolled 1,455 adult patients who were referred to the Kaiser Permanente Fontana Sleep Disorders Center. The patients were randomly assigned to a control group, which received usual care or one of three intervention arms, which included usual care plus 1) online education, 2) telemonitoring with automated feedback, and 3) both online education and telemonitoring with automated feedback .

Usual care consisted of a one-hour small-group class covering home sleep apnea testing and sleep apnea and CPAP education. After a one-week CPAP trial in those diagnosed with OSA, usual care included a follow-up visit with a respiratory therapist who reviewed the data with patients and asked about their experience with the therapy.

Those getting automated feedback received messages encouraging CPAP use by email, text, or phone based on each patient's preference. Messages were sent when CPAP use dropped below four hours on three consecutive nights and when the patient achieved Medicare adherence.

By itself, being invited by email to participate in an online interactive education program did not increase CPAP adherence. However, patients in this study arm were more likely to attend the class than those who did not receive a link to the online education program.

"We learned that both education and accountability strategies improve patient engagement, although in different ways," Dr. Hwang said. "We also learned that while patient education is important, it appears that accountability via telemonitoring is more effective at improving therapy adherence."

The authors emphasized that the improved adherence achieved with telemonitoring required no additional provider intervention or staffing resources, making it highly cost effective.

Although the overall improvement in adherence with telemonitoring was "substantial," the authors write, "the degree of response varied between individual patients." To further improve adherence, the authors recommend that future studies look at personalizing the messages based on what motivates a particular patient or based on the patient's own goals.

Still, the authors write, automatic messaging is likely to be only "one solution among a larger set of management strategies to personalize the care for individuals."
Follow Us

ATS - @atscommunity

AJRCCM - @ATSBlueEditor

About the American Journal of Respiratory and Critical Care Medicine (AJRCCM):

The AJRCCM is a peer-reviewed journal published by the American Thoracic Society. The Journal takes pride in publishing the most innovative science and the highest quality reviews, practice guidelines and statements in pulmonary, critical care and sleep medicine. With an impact factor of 12.996, it is the highest ranked journal in pulmonology. Editor: Jadwiga Wedzicha, MD, professor of respiratory medicine at the National Heart and Lung Institute (Royal Brompton Campus), Imperial College London, UK.

About the American Thoracic Society:

Founded in 1905, the American Thoracic Society is the world's leading medical association dedicated to advancing pulmonary, critical care and sleep medicine. The Society's 15,000 members prevent and fight respiratory disease around the globe through research, education, patient care and advocacy. The ATS publishes three journals, the American Journal of Respiratory and Critical Care Medicine, the American Journal of Respiratory Cell and Molecular Biology and the Annals of the American Thoracic Society

The ATS will hold its 2018 International Conference, May 18-23, in San Diego, California, where world-renowned experts will share the latest scientific research and clinical advances in pulmonary, critical care and sleep medicine.

American Thoracic Society

Related Sleep Apnea Articles from Brightsurf:

Sleep apnea may be risk factor for COVID-19
The question of sleep apnea as the risk factor for COVID-19 arose in a study conducted by the Turku University Hospital and the University of Turku on patients of the first wave of the pandemic.

Untreated sleep apnea is associated with flu hospitalization
As we approach flu season, adults with obstructive sleep apnea may want to take extra precautions.

Losing tongue fat improves sleep apnea
Using magnetic resonance imaging (MRI) to measure the effect of weight loss on the upper airway in obese patients, researchers found that reducing tongue fat is a primary factor in lessening the severity of OSA.

More cancer cases among women with sleep apnea
Women with severe sleep apnea appear to be at an elevated risk of getting cancer, a study shows.

New evidence on the association of shortened sleep time and obstructive sleep apnea with sleepiness and cardiometabolic risk factors
A new study in the journal CHEST® may change the way we think about sleep disorders.

Synthetic cannabis-like drug reduces sleep apnea
A synthetic cannabis-like drug in a pill reduced apnea and daytime sleepiness in the first large multi-site study of a drug for apnea.

Inflammation may precede sleep apnea, could be treatment target
Inflammation is traditionally thought of as a symptom of sleep apnea, but it might actually precede the disorder, potentially opening the door for new ways to treat and predict sleep apnea, according to researchers.

Concerns that sleep apnea could impact healthspan
The number of people with obstructive sleep apnea has steadily increased over the past two decades.

Sleep apnea and insomnia combination linked with depression
A new study found that men with sleep apnea and insomnia have a higher prevalence and severity of depressive symptoms than men with sleep apnea or insomnia alone.

Anti-nausea drug could help treat sleep apnea
An old pharmaceutical product may be a new treatment for obstructive sleep apnea, according to new research presented today by University of Illinois at Chicago and Northwestern University scientists at the SLEEP 2017 annual meeting in Boston.

Read More: Sleep Apnea News and Sleep Apnea Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to