title: A telehealth program for CPAP adherence reduces labor and yields similar adherence and efficacy when compared to standard of care.
abstract: OBJECTIVE
  This study evaluated the effectiveness and coaching labor requirements of a web-based automated telehealth (TH) messaging program compared with standard of care (SOC) in newly diagnosed patients with obstructive sleep apnea (OSA).
  
  
  METHODS
  In this non-blinded, multicenter, prospective study, all patients were started on continuous positive airway pressure (CPAP) with heated humidification and a wireless modem. They all received standardized CPAP education and setup. Patients in the TH group (n = 58) received an automated series of text messages and/or e-mails that were triggered by preset conditions. Patients in the SOC group (n = 64) received scheduled calls on days 1, 7, 14, and 30. Additional contacts were allowed for patients in both groups as deemed clinically necessary. Coaching labor was calculated by totaling the number and type of patient contacts and assigning historical time values.
  
  
  RESULTS
  One hundred twenty-two patients were included in the final analysis. There were no statistically significant differences between the TH and SOC groups for Medicare adherence (83 vs. 73 %), daily CPAP usage (5.1 ± 1.9 h vs. 4.7 ± 2.1 h), CPAP efficacy (mean residual apnea-hypopnea index (3.0 ± 4.1/h vs. 2.8 ± 3.8/h), or change in Epworth Sleepiness Scale score (-5.8 ± 5.5 vs. -5.1 ± 5.9), although all trends favored the TH group. There was, however, a significant reduction in the number of minutes coaching required per patient in the TH vs. SOC group (23.9 ± 26 vs. 58.3 ± 25, 59 % reduction; p < 0.0001).
  
  
  CONCLUSIONS
  Use of a web-based telehealth program for CPAP adherence coaching significantly reduced the coaching labor requirement compared with SOC, while maintaining similar adherence and effectiveness.
authors.affiliation: Sleep Data, 4420 Hotel Ct #240, San Diego, CA, 92108, USA. dmunafo@sleepdata.com.
authors.forename: Dominic
authors.initials: D
authors.lastname: Munafo
authors.affiliation: Sleep Data, 4420 Hotel Ct #240, San Diego, CA, 92108, USA.
authors.forename: William
authors.initials: W
authors.lastname: Hevener
authors.affiliation: ResMed Science Center, ResMed Corp, 9001 Spectrum Center Blvd., San Diego, CA, USA.
authors.forename: Maureen
authors.initials: M
authors.lastname: Crocker
authors.affiliation: Willes Consulting Group, Inc., 1327 Walnutview Drive, Encinitas, San Diego, CA, 92024, USA.
authors.forename: Leslee
authors.initials: L
authors.lastname: Willes
authors.affiliation: Sleep Data, 4420 Hotel Ct #240, San Diego, CA, 92108, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Sridasome
authors.affiliation: Sleep Data, 4420 Hotel Ct #240, San Diego, CA, 92108, USA.
authors.forename: Ma'an
authors.initials: M
authors.lastname: Muhsin
mesh_terms: D045422:Continuous Positive Airway Pressure / Q000191:economics / Q000523:psychology*; D003362:Cost-Benefit Analysis; D034742:Electronic Mail / Q000191:economics; D006801:Humans; D020407:Internet / Q000191:economics; D010349:Patient Compliance / Q000523:psychology*; D010353:Patient Education as Topic / Q000191:economics; D011446:Prospective Studies; D020181:Sleep Apnea, Obstructive / Q000191:economics / Q000523:psychology* / Q000628:therapy*; D017216:Telemedicine / Q000191:economics; D060145:Text Messaging / Q000191:economics; D016896:Treatment Outcome
keywords: Adherence; Compliance coaching; Continuous positive airway pressure; Labor; Obstructive sleep apnea; Telehealth