A pilot trial of a telecommunications system in sleep apnea management.
BACKGROUND
Continuous positive airway pressure (CPAP) is an effective therapy for obstructive sleep apnea syndrome (OSAS), although many patients have difficulty adhering to this therapy. The purpose of this study was to investigate the effectiveness of totally automated telephone technology in improving adherence to prescribed CPAP therapy.


METHODS
This pilot study was a randomized clinical trial in 30 patients being started on CPAP therapy for OSAS. Patients were randomly assigned to use of a computer telephone system designed to improve CPAP adherence (telephone-linked communications for CPAP [TLC-CPAP]) in addition to usual care (n = 15) or to usual care alone (n = 15) for a period of 2 months. TLC-CPAP is a computer-based system that monitors patients' self-reported behavior and provides education and reinforcement through a structured dialogue.


METHODS
A sleep symptoms checklist and the Functional Outcomes of Sleep Questionnaire were administered at study entry and at 2-month follow up. Hours of CPAP use at effective mask pressure were measured by the CPAP device, stored in its memory, and retrieved at the 2-month visit.


RESULTS
At 2 months, patients randomized to TLC-CPAP had fewer reported sleep-related symptoms (9.4 vs. 13.4, P = 0.047) than those receiving usual care. The average nightly CPAP use in the TLC-CPAP group was 4.4 hours compared with 2.9 hours (P = 0.076) in the usual-care group.


CONCLUSIONS
This pilot study suggests that patients with OSAS started on CPAP and a concurrently administered automated education and counseling system had better CPAP adherence and better control of OSAS symptoms.
DeMolles
Deborah A
DA
VA Medical Center, Boston, MA 02130, USA. deborah.demolles@med.va.gov
Sparrow
David
D
Gottlieb
Daniel J
DJ
Friedman
Robert
R
D000328:Adult; D003195:Computer Communication Networks; D045422:Continuous Positive Airway Pressure / Q000706:statistics & numerical data*; D006699:Home Care Services; D006801:Humans; D008404:Massachusetts; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010353:Patient Education as Topic / Q000379:methods; D010865:Pilot Projects; D011788:Quality of Life; D012891:Sleep Apnea Syndromes / Q000628:therapy*; D011795:Surveys and Questionnaires; D013685:Telecommunications; D013813:Therapy, Computer-Assisted; D013997:Time Factors