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Sleep-disordered breathing
Original article
A telemedicine intervention to improve adherence to continuous positive airway pressure: a randomised controlled trial
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  1. David Sparrow1,2,
  2. Mark Aloia3,
  3. Deborah A DeMolles1,
  4. Daniel J Gottlieb1,2
  1. 1VA Boston Healthcare System, Boston, Massachusetts, USA
  2. 2The Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts, USA
  3. 3National Jewish Health, Denver, Colorado, USA
  1. Correspondence to Dr David Sparrow, VA Boston Healthcare System (151N), 150 South Huntington Ave, Boston, MA 02130, USA; david.sparrow{at}va.gov

Abstract

Background Continuous positive airway pressure (CPAP) is the most widely prescribed treatment for obstructive sleep apnoea syndrome (OSAS). Although it has been shown to improve the symptoms of OSAS, many patients have difficulty adhering to this treatment. The purpose of this study was to investigate the effectiveness of an automated telemedicine intervention to improve adherence to CPAP.

Methods A randomised clinical trial was undertaken in 250 patients being started on CPAP therapy for OSAS. Patients were randomly assigned to use a theory-driven interactive voice response system designed to improve CPAP adherence (telephone-linked communications for CPAP (TLC-CPAP), n=124) or to an attention placebo control (n=126) for 12 months. TLC-CPAP monitors patients' self-reported behaviour and CPAP-related symptoms and provides feedback and counselling through a structured dialogue to enhance motivation to use CPAP. A Sleep Symptoms Checklist, the Functional Outcomes of Sleep Questionnaire, the Center for Epidemiological Studies Depression Scale and the Psychomotor Vigilance Task were administered at study entry and at 6-month and 12-month follow-up. Hours of CPAP usage at effective mask pressure were measured by the CPAP device stored in its memory and retrieved at each visit.

Results Median observed CPAP use in patients randomised to TLC-CPAP was approximately 1 h/night higher than in the control subjects at 6 months and 2 h/night higher at 12 months. Using generalised estimating equation modelling, the intervention had a significant effect on CPAP adherence. For secondary analysis, the effect of CPAP adherence on the secondary outcomes was analysed. CPAP adherence was significantly associated with a greater reduction in sleep apnoea symptoms and depressive symptoms and a greater improvement in functional status. No significant association was observed between CPAP adherence and reaction time.

Conclusions The TLC-CPAP intervention resulted in improved CPAP adherence, which was associated with improved functional status and fewer depressive symptoms.

Clinical trial.gov NCT00232544.

  • OSAS
  • CPAP therapy
  • adherence
  • quality of life
  • sleep apnoea

https://doi.org/10.1136/thx.2009.133215

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    Footnotes

    • Linked articles 140897.

    • Funding Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.

    • Competing interests MA is a paid employee of Philips/Respironics Inc and is a stockholder of Philips stock.

    • Ethics approval This study was conducted with the approval of the institutional review boards of the VA Boston Healthcare System and the Boston Medical Center and patients gave informed consent.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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