Where to Next for Optimizing Adherence in Large-Scale Trials of Continuous Positive Airway Pressure?

Personalized and Patient-Centered Strategies to Improve Positive Airway Pressure Adherence in Patients with Obstructive Sleep Apnea

“…Most interventions require substantial resources or specialized personnel not commonly available outside of a clinical trial environment and are therefore of less value for addressing PAP nonadherence clinically on a larger scale. 64 Many factors interact to predict PAP adherence, 26,63,65 and many tested interventions have been designed and developed based on factors known to influence adherence such as experienced side effects (eg, skin irritation, dryness in the nose or mouth, and abdominal bloating) 65 and psychosocial factors (eg, skills at coping with challenging situations, mental health, self-efficacy, and social support). 26,63,65,66 However, some risk factors for nonadherence are non-modifiable, such as patient characteristics (eg, age, race, socioeconomic status), 26,63,66 and disease characteristics (eg, symptom severity, OSA severity, mask type).…”

“…119 Telemonitoring, including the use of automated messaging, coaching, reinforcement emails/texts/calls/patient portal messages, education, and videoconferencing, presents additional opportunity to employ patient engagement strategies to improve PAP use. 49,64,117,[120][121][122] Early engagement by telemonitoring and subsequent outreach can prevent PAP nonadherence. 45 Trials have demonstrated telemonitoring encounters to be successful in improving PAP use 49,[122][123][124] and reducing the rate of long-term therapy termination.…”

“…117 Future studies are needed to determine the effects of continued, long-term engagement of patients via PAP telemonitoring, especially in context of clinical trials wherein adherence must be maintained in order to assess PAP effectiveness on various clinical endpoints/outcomes such as cardiovascular and metabolic risks. 64 Clear OSA telehealth algorithms and pathways can support more individualized care by applying varied telehealth engagement strategies to specific populations. For example, as previously noted, varied OSA phenotypes or patient characteristics may influence responsiveness to telemonitoring engagement strategies or intrinsic motivation to self-monitor.…”

“…Most interventions require substantial resources or specialized personnel not commonly available outside of a clinical trial environment and are therefore of less value for addressing PAP non-adherence clinically on a larger scale. 64 …”

“… 117 Future studies are needed to determine the effects of continued, long-term engagement of patients via PAP telemonitoring, especially in context of clinical trials wherein adherence must be maintained in order to assess PAP effectiveness on various clinical endpoints/outcomes such as cardiovascular and metabolic risks. 64 …”