Telehealth Services to Improve Nonadherence: A Placebo-Controlled Study

Smith, Carol E.; Dauz, Emily; Clements, Faye; Puno, Florence N.; Cook, David J.; Doolittle, Gary C.; Leeds, William

doi:10.1089/tmj.2006.12.289

Cited by 82 publications

(81 citation statements)

References 24 publications

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“…It is possible that, in the future, new technologies such as telemedicine will have a key role in these programmes [48,49], contributing to an increase in adherence [50]. In this regard, other recent studies have shown similar results to those presented in this work, supporting the validity of our approach [25,51,52].…”

Section: Group B N=22supporting

confidence: 84%

Effect of an ambulatory diagnostic and treatment programme in patients with sleep apnoea

Andreu¹,

Chiner²,

Sancho-Chust³

et al. 2011

Eur Respir J

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The aim of this study to evaluate the efficacy of a home-based programme on clinical response, continuous positive airway pressure (CPAP) compliance and cost in a population of high pre-test probability of suffering obstructive sleep apnoea syndrome (OSAS).Patients were randomised into the following three groups. Group A: home respiratory polygraphy (RP) and home follow-up; group B: hospital polysomnography and hospital followup; and group C: home RP and hospital follow-up. Evaluation during 6 months included Epworth Sleepiness Scale (ESS), Functional Outcomes Sleep Questionnaire (FOSQ), and daily activity and symptom questionnaires. Compliance was assessed by memory cards (group A) and using an hourly counter (groups B and C).66 patients were included (22 per branch), 83% were males, aged mean¡SD 52¡10 yrs, body mass index 34¡7kg?m -2 , apnoea/hypopnoea index 43¡20 h -1 , CPAP pressure 8¡2 cmH 2 O, with no between-group differences. Clinical response showed an ESS of mean¡SD 15¡3 to 6¡4, a FOSQ of 16¡3 to 18¡2, symptoms of 43¡7 to 25¡7, and activity of 37¡11 to 25¡8. At the end of the study, compliance was: group A 73%, group B 68% and group C 57%. The cost per patient was: group A J590¡43, group B J894¡11 and group C J644¡93 (p,0.001).In conclusion, patients with a high initial probability of having OSAS can be diagnosed and treated in a home setting, with a high level of CPAP compliance and lower cost than using either a hospital-based approach or home RP/hospital follow-up.

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Section: Group B N=22supporting

confidence: 84%

Effect of an ambulatory diagnostic and treatment programme in patients with sleep apnoea

Andreu¹,

Chiner²,

Sancho-Chust³

et al. 2011

Eur Respir J

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“…Most systems use cards (smart cards or SD cards), memory sticks, or wireless transmission. Several studies (64,65) have demonstrated that these transmission systems may be better than routine practice (see the online supplement for details about these studies). Although wireless transmission of CPAP adherence data is the future, a major problem with wireless systems is having the resources to retrieve the data.…”

Section: Cpap Adherence Tracking Transmission Systemsmentioning

confidence: 99%

An Official American Thoracic Society Statement: Continuous Positive Airway Pressure Adherence Tracking Systems. The Optimal Monitoring Strategies and Outcome Measures in Adults

Schwab

Badr

Epstein

et al. 2013

Am J Respir Crit Care Med

250

196

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Background: Continuous positive airway pressure (CPAP) is considered the treatment of choice for obstructive sleep apnea (OSA), and studies have shown that there is a correlation between patient adherence and treatment outcomes. Newer CPAP machines can track adherence, hours of use, mask leak, and residual apnea-hypopnea index (AHI). Such data provide a strong platform to examine OSA outcomes in a chronic disease management model. However, there are no standards for capturing CPAP adherence data, scoring flow signals, or measuring mask leak, or for how clinicians should use these data. Methods: American Thoracic Society (ATS) committee members were invited, based on their expertise in OSA and CPAP monitoring. Their conclusions were based on both empirical evidence identified by a comprehensive literature review and clinical experience. Results: CPAP usage can be reliably determined from CPAP tracking systems, but the residual events (apnea/hypopnea) and leak data are not as easy to interpret as CPAP usage and the definitions of these parameters differ among CPAP manufacturers. Nonetheless, ends of the spectrum (very high or low values for residual events or mask leak) appear to be clinically meaningful. Conclusions: Providers need to understand how to interpret CPAP adherence tracking data. CPAP tracking systems are able to reliably track CPAP adherence. Nomenclature on the CPAP adherence tracking reports needs to be standardized between manufacturers and AHI Flow should be used to describe residual events. Studies should be performed examining the usefulness of the CPAP tracking systems and how these systems affect OSA outcomes.Keywords: CPAP adherence; sleep apnea; CPAP tracking systems EXECUTIVE SUMMARYObstructive sleep apnea (OSA) is an extremely common condition and is associated with significant morbidity and mortality (1-18). Optimal treatment of sleep apnea is critical because sleepdisordered breathing is associated with the increased risk of vehicular crashes and cardiovascular morbidity and mortality (6, 9-18). Continuous positive airway pressure (CPAP) is the treatment of choice for sleep apnea (19)(20)(21)(22). Increased CPAP adherence has been shown to improve outcomes such as daytime sleepiness, quality of life, and mortality (23-25). OSA should be considered in a chronic disease management model in which CPAP adherence is tracked over time. To assess CPAP adherence and efficacy, tracking systems have been implemented. Such systems monitor CPAP efficacy (residual sleep-disordered breathing), hours of CPAP use, mask leak, and a number of different flow signals. However, there are no standards on how to use the data from these new CPAP tracking systems nor do we have evidence that these systems ultimately improve outcomes. See the online supplement for full discussion of the literature on the accuracy of the residual AHI and mask leak.The purpose of this document is to (1) review the data (adherence, leak, efficacy, flow signals) obtained from CPAP adherence tracking systems and the reliability of th...

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“…[39][40][41] Being able to predict a patient's "risk" for poor CPAP adherence early, ideally at the point of CPAP therapy initiation, may be useful in targeting "high-risk" patients for these interventions.…”

Section: S C I E N T I F I C I N V E S T I G a T I O N Smentioning

confidence: 99%

A Brief Survey of Patients' First Impression after CPAP Titration Predicts Future CPAP Adherence: A Pilot Study

Balachandran

Yu²,

Wroblewski

et al. 2013

Journal of Clinical Sleep Medicine

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Background: CPAP adherence patterns are often established very early in the course of therapy. Our objective was to quantify patients' perception of CPAP therapy using a 6-item questionnaire administered in the morning following CPAP titration. We hypothesized that questionnaire responses would independently predict CPAP adherence during the fi rst 30 days of therapy. Methods: We retrospectively reviewed the CPAP perception questionnaires of 403 CPAP-naïve adults who underwent inlaboratory titration and who had daily CPAP adherence data available for the fi rst 30 days of therapy. Responses to the CPAP perception questionnaire were analyzed for their association with mean CPAP adherence and with changes in daily CPAP adherence over 30 days. Results: Patients were aged 52 ± 14 years, 53% were women, 54% were African American, the mean body mass index (BMI) was 36.3 ± 9.1 kg/m 2 , and most patients had moderate-severe OSA. Four of 6 items from the CPAP perception questionnaireregarding diffi culty tolerating CPAP, discomfort with CPAP pressure, likelihood of wearing CPAP, and perceived health benefi t-were signifi cantly correlated with mean 30-day CPAP adherence, and a composite score from these 4 questions was found to be internally consistent. Stepwise linear regression modeling demonstrated that 3 variables were signifi cant and independent predictors of reduced mean CPAP adherence: worse score on the 4-item questionnaire, African American race, and non-sleep specialist ordering polysomnogram and CPAP therapy. Furthermore, a worse score on the 4-item CPAP perception questionnaire was consistently associated with decreased mean daily CPAP adherence over the fi rst 30 days of therapy. Conclusions:In this pilot study, responses to a 4-item CPAP perception questionnaire administered to patients immediately following CPAP titration independently predicted mean CPAP adherence during the fi rst 30 days. Further prospective validation of this questionnaire in different patient populations is warranted. S C I E N T I F I C I N V E S T I G A T I O N ST he prevalence of obstructive sleep apnea (OSA) has been well documented 1 and is expected to increase as the prevalence of obesity increases.2 Untreated OSA is associated with not just increased cardiovascular 3 and metabolic risks, 4 but also with myriad comorbidities including decreased quality of life, 5 depressed mood, 6 decreased cognitive function, 7 increased risk of motor vehicle and occupational accidents, 8,9 and increased risk of pregnancy complications.10 Though continuous positive airway pressure (CPAP) therapy is highly effi cacious 11 and is associated with decreased cardiovascular morbidity and mortality 12,13 and metabolic morbidity, 14,15 treatment effectiveness depends largely on patient adherence, which is often suboptimal. 16 Moreover, long-term patient adherence is typically established within the fi rst week of CPAP therapy. 17-19Certain factors have already been associated with poor adherence to CPAP therapy: lack of sleep specialist consultation ...

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Telehealth Services to Improve Nonadherence: A Placebo-Controlled Study

Cited by 82 publications

References 24 publications

Effect of an ambulatory diagnostic and treatment programme in patients with sleep apnoea

Effect of an ambulatory diagnostic and treatment programme in patients with sleep apnoea

An Official American Thoracic Society Statement: Continuous Positive Airway Pressure Adherence Tracking Systems. The Optimal Monitoring Strategies and Outcome Measures in Adults

A Brief Survey of Patients' First Impression after CPAP Titration Predicts Future CPAP Adherence: A Pilot Study

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