1048 Impact of Automated CPAP Tele-monitoring on CPAP Adherence At 2 Years: Follow-up From The Tele-OSA Randomized Clinical Trial

Abstract

Introduction: We previously reported results from the Tele-OSA study demonstrating improved 3-month CPAP adherence with CPAP tele-monitoring with automated patient feedback [U-Sleep; ResMed Corp] but no significant impact with telemedicine-delivered education [Emmi, Emmi Solutions Inc]. We performed a 2-year follow-up evaluating the continued impact of CPAP tele-monitoring(TM). Methods: This 4-arm randomized clinical trial was conducted at Kaiser Permanente sleep center (Fontana, CA) studying 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) Telemonitoring 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). Because primary endpoint (3-month adherence) showed improvement only with CPAP TM, patients were collapsed into TM versus non-TM groups to compare 2-year adherence. 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 between the 2 groups. % days used for TM versus non-TM were 63.4 ± 31.2% vs 52.3 ± 34.2; p<0.01 (0-3 month). TM messaging was intended to be discontinued after 3 months (although messaging was inadvertently continued in 73 patients or 27.8% of TM group). % days used was 62.5 ± 34.5% vs 56.9 ± 36.0; p=0.07 (0-1 year) and 54.2%±36.1% vs 50.7 ± 38.2%; p=0.27 (0-2 years). Month-by-month analysis showed gradual decline in % days used in TM-stop (messaging discontinued) until it mimicked non-TM at month 8 through to the 2-year point. In the TM-continued group, adherence remained improved compared to the combined non-TM+TM-stop group throughout (although lost statistical significance by month 15): 58.4 ± 41.4% vs 48.1 ± 43.9%, p=0.05 (month 12); 58.8 ± 43.4 vs 46.5 ± 43.9, p=0.03 (month 14); 42.5 ± 41.7% vs 35.8 ± 41.9%, p=0.21 (month 24). Conclusion: CPAP tele-monitoring with automated patient feedback improves adherence at 3 months. Continued feedback messaging is likely necessary to extend the duration of improved CPAP use.