A role for remote monitoring and automated messaging to boost early CPAP use in OSA?

Continuous positive airway pressure (CPAP) is the gold standard treatment for obstructive sleep apnoea (OSA) but adherence to treatment can be poor. Telemedicine can provide remote access to adherence data, patient education platforms and enhance follow-up care. This four-arm randomised trial (Hwang et al. Am J Respir Crit Care Med 2018;197:117–26) assessed the impact of two interventions, web-based OSA education (Tel-Ed) and CPAP telemonitoring with automated messaging (Tel-TM), alone or in combination (Tel-both) in patients requiring CPAP for OSA and compared their effects on CPAP adherence at 90 days to usual care. CPAP usage was evaluated in 556 patients. Usage at 90 days was significantly higher in both the Tel-TM and Tel-both compared with usual care (both P=0.0002). Odds of achieving target adherence (≥70% days with CPAP usage ≥4 hours; the level set for reimbursement in US health system) were 2.4 times higher in Tel-both compared with usual care and 1.7 times in Tel-TM. Usage fell in all four groups but the decline was slower in the Tel-TM group. Tel-Ed improved clinic attendance but not usage. Telemonitoring with automated feedback messaging …