0509 IMPACT OF AUTOMATED WEB-EDUCATION AND CPAP TELE-MONITORING ON CPAP ADHERENCE AT 3 MONTHS AND 1 YEAR: THE TELE-OSA RANDOMIZED CLINICAL TRIAL

Abstract

Introduction: The Tele-OSA study is a 4-arm randomized clinical trial evaluating the impact of two telemedicine mechanisms (OSA web education [Emmi, Emmi Solutions Inc] and; CPAP tele-monitoring with automated patient feedback [U-Sleep; ResMed Corp]) on CPAP adherence. Methods: This 4-arm randomized clinical trial was conducted at Kaiser Permanente sleep center (Fontana, CA) in patients referred for suspected OSA and appropriate for home sleep apnea testing; if indicated, CPAP was ordered with cellular connectivity. Patients were randomized into: 1) Traditional pathway (usual care); 2) Education pathway (usual care + web education); 3) Tele-monitoring pathway (usual care + automated patient feedback messaging via text/email/ phone triggered by CPAP data); 4) Both pathway (usual care + web education and tele-monitoring). CPAP adherence was compared at 3 months and 1 year. Results: 556 patients were prescribed CPAP (58.5% males; mean age 50.5 ± 12.1, BMI 34.5 ± 7.7, AHI 31.9 ± 25.8). There were no differences in baseline characteristics among the four groups. 90-day CPAP compliance (Medicare) was: Traditional 53.5%; Education 60.7%; Tele-monitoring 65.6%; Both 73.2%. Both groups receiving tele-monitoring had significantly better CPAP use compared to Traditional (Tele-monitoring pathway p=0.05; Both p<0.01), while Education did not significantly impact CPAP use (p=0.21). Telemonitoring improved usage without an increase in sleep provider intervention (Median number of encounters during this period was zero, and all means were ≤0.5). For tele-monitoring patients that stopped receiving auto-feedback messaging after 90 days, 1 year assessment showed gradual decline in adherence with use similar to the “No tele-monitoring patients” at month 12 (% days used, 48.5%±44.4% vs. 47.8%±43.7%; p=0.88). However, for tele-monitoring patients randomly selected to continue the auto-feedback messaging indefinitely (n=73; 27.8%), higher CPAP use persisted through to month 12 with a trend towards significance (% days used, 58.4%±41.1% vs. 47.8%±43.7%; p=0.06). Conclusion: CPAP tele-monitoring with automated patient feedback significantly improves adherence at 3 months without an increase in provider utilization. This study suggests that feedback messaging should be continued indefinitely for sustained effect. Telemedicine education did not impact adherence.