114 Telemetrically triggered interventions in the first month of CPAP: 6-months results of a prospective, randomized controlled trial

Abstract

Introduction: CPAP is the standard treatment for OSAS. Long term adherence is relatively low, many patients abscond in the first months of treatment. In a pilot study, we observed an improvement in 1-month adherence for patients supported with telemetrically triggered interventions. Therefore, a prospectively randomized trial was conducted. Methods: 240 symptomatic OSAS patients with an apnea-hypopnea index (AHI) of >5/h started CPAP with a structured instruction session of 1 hour, including a trial period in bed. Patients who agreed for long-term CPAP were randomized 1:1 to a telemedicine (TM) or control group (non-TM). For the TM group, CPAP usage, mask leakage and residual AHI were checked on an online data depository 3 times per week during the first month of treatment. Phone calls were undertaken if there was usage < 4h or excessive leakage for 2 consecutive nights. For all patients, data on usage and sleep and daytime quality of life (Quebec sleep Quality QSQ) was collected at 1 and 6 months of treatment.Table 1With TMNon-TMp-valN8287% male82.585.4nsAge55.2 [44.4 - 66.0]57.2 [43.8 - 65.7]nsBMI31.3 [27.5 - 34.7]31.0 [27.9 - 34.9]nsODI32.5 [17.0 - 59.0]36.0 [23.5 - 60.5]nsAHI39.0 [26.0 - 69.0]52.0 [32.5 - 70.5]nsESS10 [6 - 13]10 [7 - 13]nsQSQ sum score140.0 [103.5 - 170]151.5 [124.5 - 176.5]ns Open table in a new tab Results: 240 patients were randomized. According to the predefined protocol, 17 1-month absconders (11 TM, 6 non-TM) and 54 6-months absconders (27 TM, 27 non-TM) were excluded from analysis. Baseline characteristics of the study population were comparable in both groups (Table 1). Among TM patients, 18 (22%) had no indication for calls, 26 (32%) received 1 or 2 calls and 38 (46%) 3 or more calls. Usage data at 6 months for TM and non-TM patients are given in Table 2. Usage differences between groups were not statistically significant. In a subgroup analysis, we found that for the quartile of patients with low baseline scores in the Epworth sleepiness scale (ESS), a significant increase in usage was observed. Similarly, the quartile of patients with low baseline AHI had a significantly higher CPAP usage in the TM group. Interestingly, there was a significantly higher improvement in QSQ when comparing TM vs. non-TM from baseline to 1 month (p=0.021) and from baseline to 6 months (p=0.028).Table 2With TMNon-TMpN8287Month 1: Daily usage (h)5.7h [4.4 - 6.8]5.3 [4.2 - 7.0]0.8Month 1: % nights with CPAP used95.3 [85.4 - 98.6]95.3 [88.7 - 98.6]0.811Month 1: % nights with efficient CPAP use93.4 [80.3 - 100.0]90.1 [67.1 - 100.0]0.233Month 1: QSQ sum score174 [152 - 195]172 [150 - 194]nsMonth 6: Daily usage (h)5.6 [3.8 - 6.3]4.8 [3.3 - 6.7]0.663Month 6: % nights with CPAP used92.0 [72.3 - 98.0]88.2 [71.5 - 97.7] 0.5650.565Month 6: % nights with efficient CPAP use89.6 [79.2 - 96.7]89.6 [74.0 - 97.3]0.716QSQ sum score174 [150 - 195]169 [145 - 188]ns Open table in a new tab Conclusion: Telemetrically triggered targeted patient support during the first CPAP month did not result in a statistically significant increase in CPAP usage at 1 and 6 months of treatment in an unselected patient population. A significant improvement was observed in the subgroup of patients with low ESS scores as well as in patients with low AHI.