title: The impact of a telemedicine monitoring system on positive airway pressure adherence in patients with obstructive sleep apnea: a randomized controlled trial.
abstract: OBJECTIVE
  First-line therapy for patients with moderate to severe obstructive sleep apnea (OSA) is positive airway pressure (PAP). Although PAP is a highly efficacious treatment, adherence to PAP is still a substantial clinical problem. The objective of this study was to determine whether PAP adherence can be improved with a telemedicine monitoring system.
  
  
  METHODS
  A nonblinded, single-center, randomized controlled trial that compared standard PAP treatment versus PAP treatment and a telemedicine monitoring system
  
  
  METHODS
  University sleep disorders program in British Columbia, Canada
  
  
  METHODS
  Adult patients (≥ 19 yr of age) with moderate to severe OSA (apnea hypopnea index (AHI) ≥ 15 events/hr determined by polysomnography) prescribed PAP INTERVENTIONS: Patients were randomized to either standard care with an autotitrating PAP machine or an autotitrating PAP machine that transmitted physiologic information (i.e., adherence, air leak, residual AHI) daily to a website that could be reviewed. If problems were identified from information from the website, the patient was contacted by telephone as necessary.
  
  
  METHODS
  PAP adherence after 3 mo, subjective sleep quality, and side effects
  
  
  RESULTS
  Seventy-five patients were enrolled; 39 were randomized to telemedicine and 36 to standard care. The mean age ± standard deviation (SD) was 53.5 ± 11.2 yr, mean AHI was 41.6 ± 22.1 events/hr, and 80% of patients were male. After 3 mo, mean PAP adherence was significantly greater in the telemedicine arm (191 min per day) versus the standard arm (105 min per day; mean difference = 87 min, 95% confidence interval (CI): 25-148 min, P = 0.006, unpaired t test). On days when PAP was used, mean adherence was 321 min in the telemedicine arm and 207 min in the standard arm (difference = 113 min, 95% CI: 62-164 min, P < 0.0001). Significant independent predictors of adherence included age, baseline Epworth Sleepiness Scale score, and use of telemedicine. On average, an additional 67 min of technician time was spent on patients in the telemedicine arm compared with the standard arm (P = 0.0001).
  
  
  CONCLUSIONS
  PAP adherence can be improved with the use of a web-based telemedicine system at the initiation of treatment.
authors.affiliation: Sleep Disorders Program, University of British Columbia Hospital, Vancouver, British Columbia, Canada.
authors.forename: Nurit
authors.initials: N
authors.lastname: Fox
authors.forename: A J
authors.initials: AJ
authors.lastname: Hirsch-Allen
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Goodfellow
authors.forename: Joshua
authors.initials: J
authors.lastname: Wenner
authors.forename: John
authors.initials: J
authors.lastname: Fleetham
authors.forename: C Frank
authors.initials: CF
authors.lastname: Ryan
authors.forename: Mila
authors.initials: M
authors.lastname: Kwiatkowska
authors.forename: Najib T
authors.initials: NT
authors.lastname: Ayas
mesh_terms: D000328:Adult; D015992:Body Mass Index; D015331:Cohort Studies; D045422:Continuous Positive Airway Pressure; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D017286:Polysomnography; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D017216:Telemedicine; D013997:Time Factors; D016896:Treatment Outcome