Ann Am Thorac Soc. 2023 Jul 18. doi: 10.1513/AnnalsATS.202208-723OC. Online ahead of print.

ABSTRACT

RATIONALE: Positive airway pressure (PAP) is standard treatment for obstructive sleep apnea (OSA). Telemedicine has been introduced for improved PAP follow-up.

OBJECTIVE: Our study aim was to evaluate clinical utility and patient satisfaction of PAP follow-up with an early intervention telemedical protocol.

METHODS: Randomized, controlled trial conducted at four sleep clinics of the same county. Treatment naive OSA patients were randomized to standard PAP follow-up (203 patients, fixed follow-up procedures) or early intervention telemedical follow-up (Air View, ResMed; 206 patients, continuous follow-up) for 3 months. Evaluated variables included PAP adherence at 3 months, patient-related outcome measures (Epworth Sleepiness Scale, Short Form 36, Insomnia Severity Scale, Hospital Anxiety and Depression Scale), and staff time. Group differences were analyzed with linear mixed regression models adjusted for age, Body Mass Index (BMI) and Apnea Hypopnea Index, and study center.

RESULTS: The study groups were comparable at baseline (N=409, mean age 59±12 years, BMI 31.9±6 kg/m2, AHI 41.5±21 n/h). PAP adherence was higher in the proactive telemedicine compared with the control group (4.3±2.4 and 4.1±2.6 hours/night, P=0.01, respectively) and mean mask pressure at follow-up was significantly lower in the telemedicine group, 8.7 ±2.1 cm/H20 compared to 9.2cm±2.5 cm/H20 in the control group (p=0.028). In post-hoc analysis the difference was most pronounced in patients with depression (4.8±2.6 vs 2.7±2.3 hours/night, p=0.03). Relevant mask leakage (>24 l/min) was lower in the telemedicine group (N=5.4% versus N=12.1%, P=0.024, respectively). Improvement of patient related outcome measures and patient satisfaction were equivalent between groups.

CONCLUSIONS: Proactive telemedical management of the initial follow-up of PAP treatment compared favorably to conventional follow-up in terms of adherence, pressure level, and mask leakage. Patients with depression may particularly benefit from telemedical follow-up. Specific clinical routines are required to establish this practice in sleep clinics.

CLINICALTRIALS: gov NCT03446560.

PMID:37463309 | DOI:10.1513/AnnalsATS.202208-723OC