title: CPAP treatment supported by telemedicine does not improve blood pressure in high cardiovascular risk OSA patients: a randomized, controlled trial.
abstract: OBJECTIVE
  Obstructive sleep apnea (OSA) has been associated with hypertension, which is one of the intermediary mechanisms leading to increased cardiovascular morbidity. This study aimed at evaluating the effects of a combination of continuous positive airway pressure (CPAP) and telemedicine support on blood pressure (BP) reduction in high cardiovascular risk OSA patients.
  
  
  METHODS
  A multi-center randomized controlled trial that compared standard CPAP care and CPAP care and a telemedicine intervention.
  
  
  METHODS
  Sleep clinics in France.
  
  
  METHODS
  107 adult (18-65 years old) OSA patients (AHI > 15 events/h) with a high cardiovascular risk (cardiovascular SCORE > 5% or secondary prevention).
  
  
  METHODS
  Patients were randomized to either standard care CPAP (n = 53) or CPAP and telemedicine (n = 54). Patients assigned to telemedicine were equipped with a smartphone for uploading BP measurements, CPAP adherence, sleepiness, and quality of life data; in return, they received pictograms containing health-related messages.
  
  
  METHODS
  The main outcome was home self-measured BP and secondary outcomes were cardiovascular risk evolution, objective physical activity, CPAP adherence, sleepiness and quality of life.
  
  
  RESULTS
  Self-measured BP did not improve in either group (telemedicine or standard care). Patients in primary prevention showed greater BP reduction with CPAP treatment than those in secondary prevention.
  
  
  CONCLUSIONS
  CPAP treatment supported by telemedicine alone did not improve blood pressure and cardiovascular risk in high cardiovascular risk OSA patients. This study emphasizes the need for diet and physical activity training programs in addition to CPAP when aiming at decreasing cardiometabolic risk factors in these patients.
  
  
  BACKGROUND
  ClinicalTrials.gov identifier: NCT01226641.
authors.affiliation: Univ Grenoble Alpes, HP2 laboratory, Grenoble, France ; Inserm U1042, HP2, Grenoble, France ; CHU Grenoble, HP2, Grenoble, France.
authors.forename: Monique
authors.initials: M
authors.lastname: Mendelson
authors.affiliation: Univ Grenoble Alpes, HP2 laboratory, Grenoble, France ; Inserm U1042, HP2, Grenoble, France ; CHU Grenoble, HP2, Grenoble, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Vivodtzev
authors.affiliation: Univ Grenoble Alpes, HP2 laboratory, Grenoble, France ; Inserm U1042, HP2, Grenoble, France ; CHU Grenoble, HP2, Grenoble, France.
authors.forename: Renaud
authors.initials: R
authors.lastname: Tamisier
authors.affiliation: IP Santé Domicile, Lyon, France.
authors.forename: David
authors.initials: D
authors.lastname: Laplaud
authors.affiliation: Univ Grenoble Alpes, HP2 laboratory, Grenoble, France ; Inserm U1042, HP2, Grenoble, France ; CHU Grenoble, HP2, Grenoble, France.
authors.forename: Sonia
authors.initials: S
authors.lastname: Dias-Domingos
authors.affiliation: Cardiology Clinic, CHU Grenoble, France.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Baguet
authors.affiliation: Polyclinique de Gentilly, Nancy, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Moreau
authors.affiliation: Service de Pneumologie, Saint Avold, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Koltes
authors.affiliation: Cabinet Marcel Benoit, Grenoble, France.
authors.forename: Léonidas
authors.initials: L
authors.lastname: Chavez
authors.affiliation: Cabinet Marcel Benoit, Grenoble, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: De Lamberterie
authors.affiliation: Dieulefit Santé, Domaine Chamonix, Dieulefit, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Herengt
authors.affiliation: Univ Grenoble Alpes, HP2 laboratory, Grenoble, France ; Inserm U1042, HP2, Grenoble, France ; CHU Grenoble, HP2, Grenoble, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Levy
authors.affiliation: Univ Grenoble Alpes, HP2 laboratory, Grenoble, France ; Inserm U1042, HP2, Grenoble, France ; CHU Grenoble, HP2, Grenoble, France.
authors.forename: Patrice
authors.initials: P
authors.lastname: Flore
authors.affiliation: Univ Grenoble Alpes, HP2 laboratory, Grenoble, France ; Inserm U1042, HP2, Grenoble, France ; CHU Grenoble, HP2, Grenoble, France.
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Pépin
mesh_terms: D001794:Blood Pressure; D040421:Cell Phone; D045422:Continuous Positive Airway Pressure; D004032:Diet; D005081:Exercise Therapy; D005260:Female; D005602:France; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012306:Risk; D020181:Sleep Apnea, Obstructive / Q000150:complications / Q000503:physiopathology* / Q000628:therapy*; D012894:Sleep Stages / Q000502:physiology; D017216:Telemedicine
keywords: blood pressure; cardiovascular risk; obstructive sleep apnea; telemedicine