Telemonitoring and automated messages improve CPAP adherence

September 12, 2017
Automatic positive messages improve CPAP adherence. Credit: ATS

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 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 ," 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 , 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 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 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 ." 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."

Explore further: CPAP doesn't alter renal function in coexisting OSA, CVD

Related Stories

CPAP doesn't alter renal function in coexisting OSA, CVD

August 11, 2017
(HealthDay)—For individuals with coexisting obstructive sleep apnea (OSA) and cardiovascular disease, continuous positive airway pressure (CPAP) does not alter renal function, according to a study published online July ...

Study finds that CPAP therapy reduces acid reflux in people with sleep apnea

October 3, 2016
A new study suggests that CPAP therapy may help improve the symptoms of nocturnal gastroesophageal reflux in patients with obstructive sleep apnea.

Family support may improve adherence to CPAP therapy for sleep apnea

May 29, 2014
A new study suggests that people with obstructive sleep apnea (OSA) who are single or have unsupportive family relationships may be less likely to adhere to continuous positive airway pressure (CPAP) therapy.

2.5 hours of patient/therapist contact time increases CPAP use

October 22, 2012
Although continuous positive airway pressure (CPAP) is often used as therapy for obstructive sleep apnea (OSA), patient compliance with CPAP remains an issue.

SAVE - sleep apnea treatment: No cardiovascular benefit

August 29, 2016
More than 3 years of nightly treatment with a continuous positive airway pressure (CPAP) machine did not reduce cardiovascular risk more than usual care among patients with cardiovascular disease and obstructive sleep apnea ...

Basal metabolic rate down after CPAP initiation in OSA

November 10, 2016
(HealthDay)—For patients with obstructive sleep apnea (OSA), treatment with continuous positive airway pressure (CPAP) is associated with a decrease in basal metabolic rate (BMR), according to a study published recently ...

Recommended for you

Inflammation may precede sleep apnea, could be treatment target

September 1, 2017
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.

More evidence: Untreated sleep apnea shown to raise metabolic and cardiovascular stress

August 31, 2017
Sleep apnea, left untreated for even a few days, can increase blood sugar and fat levels, stress hormones and blood pressure, according to a new study of sleeping subjects. A report of the study's findings, published in the ...

Sleep patterns contribute to racial differences in disease risk

August 18, 2017
Poor sleep patterns could explain, in part, the differences in the risk of cardiometabolic disease between African-Americans and European-Americans, according to a new study published in Proceedings of the National Academy ...

Concerns that sleep apnea could impact healthspan

July 27, 2017
The number of people with obstructive sleep apnea has steadily increased over the past two decades. The disorder, which causes a person to briefly stop breathing when asleep, affects over 100 million people globally and is ...

Anti-nausea drug could help treat sleep apnea

June 6, 2017
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 ...

New disposable, wearable patch found to effectively detect sleep apnea

June 4, 2017
Results of a definitive clinical trial show that a new, disposable diagnostic patch effectively detects obstructive sleep apnea across all severity levels.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.