Telemedicine follow-up for positive airway pressure shows adherence benefits
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Key takeaways:
- Telemedicine vs. standard follow-up resulted in better positive airway pressure adherence and mask pressure levels.
- Patients with depression or comorbidity demonstrated longer adherence with telemedicine.
Patients on positive airway pressure demonstrated better measures of adherence and mask pressure and leakage when followed-up with telemedicine vs. standard care, according to results published in Annals of the American Thoracic Society.
“Our study indicates that proactive telemedicine may be a favorable alternative in routines for [positive airway pressure] follow-up,” Benedikt Fridriksson, MD, of the department of respiratory medicine at Sahlgrenska University Hospital, and colleagues wrote.
In a multicenter randomized controlled trial, Fridriksson and colleagues evaluated 409 patients (mean age, 58.7 years; 24.3% women) with obstructive sleep apnea who have not received treatment to see how 3-month positive airway pressure (PAP) adherence, staff time and measures of sleepiness, health-related quality of life, insomnia, anxiety and depression differed between those who had early intervention telemedical follow-up (n = 206; AirView, ResMed) and those who had standard follow-up (n = 203).
Researchers compared both sets of patients using linear mixed regression models that accounted for several variables: age, sex, BMI, apnea-hypopnea index (AHI), Epworth Sleepiness Scale (ESS) and study center (four total).
Between both groups, researchers noted similar measures of BMI, OSA severity and comorbidity burden at baseline.
In terms of PAP adherence, patients in the telemedicine follow-up group demonstrated a slightly longer mean compliance of 4.3 hours per night vs. 4.1 hours per night among patients in the standard follow-up group (P = .014).
Additionally, researchers found significantly reduced mask pressure among patients in the telemedicine group vs. the standard group (mean, 8.7 cm/H2O vs. 9.2 cm/H2O; P = .028), as well as a smaller prevalence of abnormal nonintentional mask leak (more than 24 L/minute, 5.4% vs. 12.1%; P = .024).
Other factors related to PAP, such as the number of follow-up days using PAP, PAP discontinuation, rates of PAP adherence of at least 4 hours per night, 3-month median residual AHI and the proportion of switching mask types, did not significantly differ between both groups.
Similarly, both sets of patients had comparable changes in scores on the ESS, Short Form 36 (health-related quality of life), Insomnia Severity Scale and Hospital Anxiety and Depression Scale, according to researchers.
Further, the amount of time staff spent with each patient across the four centers did not significantly differ between both groups.
Despite all the similar measures found between both patient cohorts, researchers found extended PAP adherence with telemedicine vs. standard follow-up among patients with depression (4.8 hours per night vs. 2.7 hours per night) and patients with a known comorbidity (4.3 hours per night vs. 4 hours per night) in post-hoc analysis.
“We found that patients with depression showed substantially increased PAP adherence with telemedicine follow-up,” Fridriksson and colleagues wrote. “Future prospective interventional trials could address the feasibility of tailored PAP intervention for this group.”
Perspective
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This study examined the idea that a telemedicine intervention, after a patient has received a PAP device, would improve PAP compliance. The study was performed at four different centers with a control group and appropriate statistics were used for the values measured. Initially there were significant but not large differences between the two groups (consult vs. control). Those that received the telemedicine support did tend to use the PAP device a bit longer. However, when results were viewed by depression scores, a more pronounced effect was seen. Basically, people who are diagnosed with sleep apnea who are placed on PAP and also have depression appear to use the device significantly longer when participating in a telemedicine consult than those who do not have depression.
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