Abstract
BackgroundPoor adherence to continuous positive airway pressure (CPAP) treatment by adults with obstructive sleep apnea (OSA) is a common issue. Strategies delivered by means of information and communication technologies (ie, eHealth) can address treatment adherence through patient education, real-time monitoring of apnea symptoms and CPAP adherence in daily life, self-management, and early identification and subsequent intervention when device or treatment problems arise. However, the effectiveness of available eHealth technologies in improving CPAP adherence has not yet been systematically studied.ObjectiveThis meta-analytic review was designed to investigate the effectiveness of a broad range of eHealth interventions in improving CPAP treatment adherence.MethodsWe conducted a systematic literature search of the databases of Cochrane Library, PsycINFO, PubMed, and Embase to identify relevant randomized controlled trials in adult OSA populations. The risk of bias in included studies was examined using seven items of the Cochrane Collaboration risk-of-bias tool. The meta-analysis was conducted with comprehensive meta-analysis software that computed differences in mean postintervention adherence (MD), which was defined as the average number of nightly hours of CPAP use.ResultsThe meta-analysis ultimately included 18 studies (N=5429 adults with OSA) comprising 22 comparisons between experimental and control conditions. Postintervention data were assessed at 1 to 6 months after baseline, depending on the length of the experimental intervention. eHealth interventions increased the average nightly use of CPAP in hours as compared with care as usual (MD=0.54, 95% CI 0.29-0.79). Subgroup analyses did not reveal significant differences in effects between studies that used eHealth as an add-on or as a replacement to care as usual (P=.95), between studies that assessed stand-alone eHealth and blended strategies combining eHealth with face-to-face care (P=.23), or between studies of fully automated interventions and guided eHealth interventions (P=.83). Evidence for the long-term follow-up effectiveness of eHealth adherence interventions remains undecided owing to a scarcity of available studies and their mixed results.ConclusionseHealth interventions for adults with OSA can improve adherence to CPAP in the initial months after the start of treatment, increasing the mean nightly duration of use by about half an hour. Uncertainty still exists regarding the timing, duration, intensity, and specific types of eHealth interventions that could be most effectively implemented by health care providers.
Highlights
Obstructive sleep apnea (OSA) is a clinical sleep disorder characterized by recurrent episodes of partial or complete obstruction of the respiratory passages during sleep [1,2]
Postintervention data were assessed at 1 to 6 months after baseline, depending on the length of the experimental intervention. electronic health obstructive sleep apnea (OSA) (eHealth) interventions increased the average nightly use of continuous positive airway pressure (CPAP) in hours as compared with care as usual (MD=0.54, 95% CI 0.29-0.79)
Subgroup analyses did not reveal significant differences in effects between studies that used eHealth as an add-on or as a replacement to care as usual (P=.95), between studies that assessed stand-alone eHealth and blended strategies combining eHealth with face-to-face care (P=.23), or between studies of fully automated interventions and guided eHealth interventions (P=.83)
Summary
Obstructive sleep apnea (OSA) is a clinical sleep disorder characterized by recurrent episodes of partial or complete obstruction of the respiratory passages during sleep [1,2]. Continuous positive airway pressure (CPAP) is considered the gold standard for the treatment of patients with moderate-to-severe OSA. It involves wearing a mask during sleep that uses a pump to provide a constant flow of air (pressure) to the throat to keep the airway open. Treatment with CPAP is highly effective for normalizing breathing and sleep; it reduces the frequency of respiratory events during sleep, decreases daytime sleepiness, and improves blood pressure and quality of life [5,6]. HETEROGI: Stata module to quantify heterogeneity in a meta-analysis URL: https://EconPapers. Poor adherence to continuous positive airway pressure (CPAP) treatment by adults with obstructive sleep apnea (OSA) is a common issue. The effectiveness of available eHealth technologies in improving CPAP adherence has not yet been systematically studied
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