Telemedicine Strategy to Rescue CPAP Therapy in Sleep Apnea Patients with Low Treatment Adherence: A Pilot Study.

Onintza Garmendia,Monique Suarez-Girón,Raisa Cebrian,Laura Saura,Concepción Ruiz,Josep M Montserrat,Carmen Monasterio,Miguel A Negrín,Ramon Farré,Marta Torres

doi:10.3390/jcm10184123

Abstract

Patients with sleep apnea are usually treated with continuous positive airway pressure (CPAP). This therapy is very effective if the patient′s adherence is satisfactory. However, although CPAP adherence is usually acceptable during the first months of therapy, it progressively decreases, with a considerable number of patients accepting average treatment duration below the effectiveness threshold (4 h/night). Herein, our aim was to describe and evaluate a novel telemedicine strategy for rescuing CPAP treatment in patients with low adherence after several months/years of treatment. This two-week intervention includes (1) patient support using a smartphone application, phone and voice recorder messages to be answered by a nurse, and (2) daily transmission and analysis of signals from the CPAP device and potential variation of nasal pressure if required. On average, at the end of the intervention, median CPAP adherence considerably increased by 2.17 h/night (from 3.07 to 5.24 h/night). Interestingly, the procedure was able to markedly rescue CPAP adherence: the number of patients with poor adherence (<4 h/night) was considerably reduced from 38 to 7. After one month, adherence improvement was maintained (median 5.09 h/night), and only 13 patients had poor adherence (<4 h/night). This telemedicine intervention (103€ per included patient) is a cost-effective tool for substantially increasing the number of patients with CPAP adherence above the minimum threshold for achieving positive therapeutic effects.

Highlights

The obstructive sleep apnea (OSA) syndrome is a highly prevalent chronic disorder associated with substantial morbidity, resulting in considerable healthcare costs [1,2,3]
After starting with Continuous positive airway pressure (CPAP) treatment, the first visit was at 15–30 days, the second one after 3 months, the third visit was after 6 months, and a fourth visit 1 year after prescription
The requirement of training the health care professionals involved, the need of phenotyping which patients should be included in a telemedicine program, or better defining the cost for the health system but the social and labor costs saved by correctly treated patients. This is the first study that deals with the CPAP adherence rescue concept in patients under long-term treatment

Summary

Introduction

The obstructive sleep apnea (OSA) syndrome is a highly prevalent chronic disorder associated with substantial morbidity, resulting in considerable healthcare costs [1,2,3]. Continuous positive airway pressure (CPAP) is by far the most widespread and effective therapy for OSA and is the gold standard treatment for this sleep breathing disorder [4]. Suboptimal patient adherence to CPAP is common [5,6] despite using conventional interventions to increase it [7]. Regarding the clinical effectiveness of CPAP, it is important to mention that treatment adherence of 4 h per night is currently considered the minimum required. Data in the literature describing the dose-response relationship between CPAP usage and improved clinical outcomes (including sleepiness, functional status, and hypertension) strongly suggest setting an adherence threshold of

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