Telemonitoring in continuous positive airway pressure-treated patients improves delay to first intervention and early compliance: a randomized trial

• Published in: Sleep medicine 2017-11, Vol.39, p.77-83
• Main Authors: Hoet, F., Libert, W., Sanida, C., Van den Broecke, S., Bruyneel, A.V., Bruyneel, M.
• Format: Article
• Language: English
• Subjects: Compliance; Continuous positive airway pressure; Continuous Positive Airway Pressure - methods; Female; Humans; Male; Middle Aged; Obstructive sleep apnea syndrome; Patient Compliance; Patient Education as Topic; Sleep Apnea, Obstructive - therapy; Telemedicine; Telemedicine - instrumentation; Telemedicine - methods; Telemonitoring
• ISSN: 1389-9457; 1878-5506
• DOI: 10.1016/j.sleep.2017.08.016

Telemonitoring (TM) has been used in continuous positive airway pressure (CPAP)−treated patients to improve compliance, but results have been inconsistent. The purpose of this study was to assess the impact of TM on the delay to the first technical intervention after CPAP initiation. The impact of TM on mean compliance during the first 3 months of treatment was measured as a secondary outcome. Patients diagnosed with moderate to severe obstructive sleep apnea syndrome were prospectively included and randomized to receive usual care (UC) or TM. In both arms, an educational session was scheduled 1 month after CPAP initiation, and medical visits were planned after 1.5 and 3 months. In the TM arm, we added a universal TM unit (T4P) to the CPAP device. Delay to first intervention was significantly shorter in the TM group (29 ± 25 vs 47 ± 30 days, p = 0.02). The first intervention in the TM group was motivated by detection of problems by the TM system in 39% of patients. Compliance at 3 months was significantly better in the TM group (5.7 ± 1.6 vs 4.2 ± 1.9 h/night, p = 0.018). This is the first randomized study showing that TM reduces delay to first technical intervention in CPAP-treated patients. This early activation of troubleshooting was associated with improved compliance at 3 months. Since CPAP side effects at 1 month have been shown to predict lower 12-month CPAP compliance, TM seems to be an excellent tool for improvement of long-term CPAP acceptance. [Display omitted] •What was already known before this study?•It is a challenge to obtain adequate continuous positive airway pressure (CPAP) compliance•Early compliance (at 1 week or 1 month) is associated with better 6-month compliance•Impact of telemonitoring on compliance remains controversial•What does this study add to the body of knowledge?•TM reduces delay to first technical intervention in CPAP-treated patients•Early resolution of troubleshooting is associated with improved compliance at 3 months