title: Web-Based Access to Positive Airway Pressure Usage with or without an Initial Financial Incentive Improves Treatment Use in Patients with Obstructive Sleep Apnea.
abstract: OBJECTIVE
  We tested whether providing adults with obstructive sleep apnea (OSA) with daily Web-based access to their positive airway pressure (PAP) usage over 3 mo with or without a financial incentive in the first week improves adherence and functional outcomes.
  
  
  METHODS
  Academic- and community-based sleep centers.
  
  
  METHODS
  One hundred thirty-eight adults with newly diagnosed OSA starting PAP treatment.
  
  
  METHODS
  Participants were randomized to: usual care, usual care with access to PAP usage, or usual care with access to PAP usage and a financial incentive. PAP data were transmitted daily by wireless modem from the participants' PAP unit to a website where hours of usage were displayed. Participants in the financial incentive group could earn up to $30/day in the first week for objective PAP use ≥ 4 h/day.
  
  
  RESULTS
  Mean hours of daily PAP use in the two groups with access to PAP usage data did not differ from each other but was significantly greater than that in the usual care group in the first week and over 3 mo (P < 0.0001). Average daily use (mean ± standard deviation) during the first week of PAP intervention was 4.7 ± 3.3 h in the usual care group, and 5.9 ± 2.5 h and 6.3 ± 2.5 h in the Web access groups with and without financial incentive respectively. Adherence over the 3-mo intervention decreased at a relatively constant rate in all three groups. Functional Outcomes of Sleep Questionnaire change scores at 3 mo improved within each group (P < 0.0001) but change scores of the two groups with Web access to PAP data were not different than those in the control group (P > 0.124).
  
  
  CONCLUSIONS
  Positive airway pressure adherence is significantly improved by giving patients Web access to information about their use of the treatment. Inclusion of a financial incentive in the first week had no additive effect in improving adherence.
authors.affiliation: Center for Health Equity Research and Promotion and Department of Medicine, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA.|Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
authors.forename: Samuel T
authors.initials: ST
authors.lastname: Kuna
authors.affiliation: Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.|Leonard Davis Institute Center for Health Incentives and Behavioral Economics, Philadelphia, PA.
authors.forename: David
authors.initials: D
authors.lastname: Shuttleworth
authors.affiliation: Lankenau Medical Center, Wynnewood, PA.
authors.forename: Luqi
authors.initials: L
authors.lastname: Chi
authors.affiliation: Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
authors.forename: Sharon
authors.initials: S
authors.lastname: Schutte-Rodin
authors.affiliation: Paoli Hospital, Paoli, PA.
authors.forename: Eliot
authors.initials: E
authors.lastname: Friedman
authors.affiliation: Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
authors.forename: Hengyi
authors.initials: H
authors.lastname: Guo
authors.affiliation: Holy Redeemer Hospital, Meadowbrook, PA.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Dhand
authors.affiliation: Leonard Davis Institute Center for Health Incentives and Behavioral Economics, Philadelphia, PA.
authors.forename: Lin
authors.initials: L
authors.lastname: Yang
authors.affiliation: Leonard Davis Institute Center for Health Incentives and Behavioral Economics, Philadelphia, PA.
authors.forename: Jingsan
authors.initials: J
authors.lastname: Zhu
authors.affiliation: Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
authors.forename: Scarlett L
authors.initials: SL
authors.lastname: Bellamy
authors.affiliation: Center for Health Equity Research and Promotion and Department of Medicine, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA.|Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.|Leonard Davis Institute Center for Health Incentives and Behavioral Economics, Philadelphia, PA.|Department of Health Care Management, The Wharton School of the University of Pennsylvania, Philadelphia, PA.
authors.forename: Kevin G
authors.initials: KG
authors.lastname: Volpp
authors.affiliation: Center for Health Equity Research and Promotion and Department of Medicine, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA.|Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.|Leonard Davis Institute Center for Health Incentives and Behavioral Economics, Philadelphia, PA.|Department of Health Care Management, The Wharton School of the University of Pennsylvania, Philadelphia, PA.
authors.forename: David A
authors.initials: DA
authors.lastname: Asch
mesh_terms: D045422:Continuous Positive Airway Pressure / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007182:Income; D020407:Internet; D008297:Male; D008875:Middle Aged; D009042:Motivation; D010349:Patient Compliance / Q000523:psychology / Q000706:statistics & numerical data*; D017286:Polysomnography; D020181:Sleep Apnea, Obstructive / Q000191:economics* / Q000628:therapy*; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
keywords: adherence; internet; telehealth