Abstract
The benefits of CPAP demonstrated in clinical trials are difficult to deliver in real life due to the lack of adherence. We analysed the effect of a Telemonitoring (TM)-related intervention on adherence as part of a Service Improvement Project (SIP) analysed as a retrospective cohort study. The ‘historical control’ (HC) cohort (followed up in conventional clinics) included all patients who commenced on CPAP between 1 February and 30 April 2019 (n = 142). The ‘telemonitoring’ (TM) cohort included all patients who commenced on CPAP between 1 May and 31 July 2019 (n = 166). Adherence was checked at 30 days (baseline) and 73 days for both cohorts. Wilcoxon—Rank test was used for statistical analysis (results reported as mean ± SEM). Both cohorts had similar adherence at the 30-day baseline, compared to a significantly lower adherence in the HC-cohort at 73 days (55.7 ± 3.0 vs. 51.8 ± 3.2% of days ≥ 4 h: p = 0.0072, average usage 255 ± 12.8 vs. 236 ± 13.7 min: p = 0.0003). There was a significantly higher adherence in the TM-cohort at 73 days (50.8 ± 2.5 vs. 56.1 ± 2.9% of days ≥ 4 h: p = 0.0075; average usage 234 ± 10.4 vs. 252 ± 12.1 min: p = 0.0456). Telemonitoring-feedback is effective at improving adherence with CPAP, suggesting its potential beneficial role in the community setting, particularly in the post-COVID reality of increased remote consultations.
Highlights
Obstructive Sleep apnoea (OSA) is a sleep-related respiratory disorder characterised by repetitive, partial, or complete collapse of the pharynx due to ineffective breathing effort, resulting in interruption of ventilation during sleep [1,2], causing sleep fragmentation and arterial hypoxemia
We found that we had limited capacity for face-to-face follow-up as our centre is a high-volume centre
142participants participantswere were included historic control (HCA), while participants were included in the intervention arm (IA)
Summary
Obstructive Sleep apnoea (OSA) is a sleep-related respiratory disorder characterised by repetitive, partial, or complete collapse of the pharynx due to ineffective breathing effort, resulting in interruption of ventilation during sleep [1,2], causing sleep fragmentation and arterial hypoxemia. Positive Airway Pressure (CPAP) is the gold standard therapy for adults with moderate to severe OSA [7]. It works by delivering a continuous flow of room air through nasal or oronasal masks to pneumatically splint the upper airway and maintain patency, improving most outcomes of OSA [8,9]. A patient is deemed compliant if the average usage is ≥4 h and at least 70% of the nights have ≥4 h usage [10], the level required to gain meaningful benefit from treatment with respect to reduction in symptoms of daytime sleepiness, and improved health-related quality of life, mood, and attendance at work. It is important to use this composite figure as average usage alone may not accurately reflect the adherence to therapy (i.e., the number of nights that the patient attempts to use CPAP), in patients with unhealthy lifestyles [15,16]
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