Telemonitoring improves positive airway pressure adherence in Black, Hispanic patients
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Key takeaways:
- With usual care, Black and Hispanic vs. non-Black and non-Hispanic patients use positive airway pressure for less time nightly.
- This disparity was not found with use of a telemonitoring intervention.
Among patients with obstructive sleep apnea prescribed positive airway pressure, telemonitoring improved treatment adherence in Black and Hispanic patients to a similar level as white patients, according to research presented at SLEEP 2024.
Researchers previously found that a telemonitoring intervention (U-Sleep, ResMed), which sent patients automated messages when they had low PAP usage, improved device adherence at 3 months.
PAP adherence over 2 years was also higher among those who inadvertently continued the intervention indefinitely vs. those who received usual care, according to researchers.
“The tele-messaging intervention applied in the Tele-OSA trial resulted in higher PAP usage without any increase in health care utilization,” Dennis Hwang, MD, medical director of the Kaiser Permanente Fontana Sleep Disorders Center and co-chair for sleep medicine for the Southern California Permanente Medical Group, told Healio.
“There was no rise in telephone calls, office visits or other encounters with health care providers, indicating that the tele-messaging had a direct effect on usage behavior,” he added. “Simple, cost-effective solutions like this are currently available for adoption by everyday clinicians to improve patient adherence and outcomes.”
In a subgroup analysis of the Tele-OSA clinical trial, Hwang and colleagues assessed 556 patients (mean age, 50.5 years; 58.6% men; mean AHI, 31.9 events/hour) with OSA starting PAP (AirSense 10, AutoCPAP) to see if adherence among those inadvertently continuing the telemonitoring intervention indefinitely and those receiving usual care differed based on race/ethnicity, specifically Black and Hispanic patients vs. patients of other races/ethnicities.
When divided by race/ethnicity, this cohort included 221 Hispanic patients, 48 Black patients and 287 patients of other races/ethnicities, such as white (n = 233) and Asian (n = 39).
Findings
At four time points throughout the course of 2 years, mean PAP adherence in the usual care group was always lower among Black and Hispanic patients vs. patients of other races/ethnicities.
Mean adherence at 3 to 6 months for Black and Hispanic patients was 170.9 minutes per night, whereas adherence among non-Black and non-Hispanic patients was 195.5 minutes per night. This pattern continued at 6 to 12 months (144.2 vs. 167.1 minutes per night), 12 to 18 months (128 vs. 158.9 minutes per night) and 18 to 24 months (119.5 vs. 148.1 minutes per night).
In contrast to the above findings, mean PAP adherence in the telemonitoring intervention group over 2 years was higher among Black and Hispanic patients vs. patients of other races/ethnicities.
At 3 to 6 months, Black and Hispanic patients used PAP for an average of 251.8 minutes a night, whereas non-Black and non-Hispanic patients used PAP for an average of 235.2 minutes a night. This pattern continued at 6 to 12 months (211.2 vs. 204.9 minutes per night), 12 to 18 months (190.4 vs. 180.3 minutes per night) and 18 to 24 months (163.3 vs. 158.9 minutes per night).
“While we anticipated that PAP use would be lower for Black and Hispanic patients with OSA, as reported in the literature, and we expected the tele-messaging intervention to improve PAP usage, we were surprised by the relative magnitude of the effect,” Hwang said. “The intervention’s impact was substantially greater for Black and Hispanic patients compared to other racial/ethnic groups, to the extent that the usage disparity disappeared.”
Future research
Moving forward, Hwang told Healio there are current efforts to increase the library of messages in the telemonitoring intervention.
“This enhanced library will include not only basic reminders but also extensive educational information, cognitive behavioral and motivational support, and detailed guidance on various PAP troubleshooting domains,” he said. “Our goal is to promote patient self-management and deliver personalized PAP management, with the aim of improving long-term PAP usage over a 2-year period.
“This initiative is a potential step towards a future where generative AI could play a key role in patient management, offering even more tailored and responsive support,” he added.
Researchers are also studying how they can improve the intervention for Hispanic patients.
“We have translated the support messages into Spanish and reviewed them with Spanish-speaking clinician and patient stakeholders to ensure cultural and linguistic adaptation,” Hwang said. “This targeted approach aims to address the unique needs of Hispanic patients, further promoting health equity and improving PAP adherence in this community.”
Lastly, Hwang hopes that as technology use grows, care will become more equal.
“In addition to a future in health care where AI will play a significant role in health care delivery and become embedded in virtually every aspect of care, we also aim to provide a more holistic approach to our interventions and outcome goals. This includes innovations such as enhancing the sophistication of remote monitoring, enabling us to directly impact comorbid outcomes such as hypertension, diabetes and heart disease. We envision a future where technology allows for advanced personalization of care, eliminating disparities and achieving equitable care for all people. “