Randomized controlled trial on the effect of a 12-month telemedicine program in patients with obstructive sleep apnea on continuous positive airway pressure treatment

Background: telemedicine is an essential tool to follow patients with obstructive sleep apnea (OSA) on CPAP. Objective: to establish whether in patients with OSA a 12-month follow-up program by a remote medical centre (RMC), functioning as an intermediary between patients and OSA Unit (OU), affects CPAP use compared to patients on usual care (UC). Methods: in a randomized controlled trial we enrolled 91 patients initiating CPAP in the RMC group and 101 in the UC group. The RMC performed all interventions remotely. Primary outcomes were nightly hours of CPAP use and adherence. Results: in patients with initial adaptation difficulties (<4h night) mean nightly use of CPAP increased (1st to 12th month) from 2.5 ± 0.8 to 4.3 ± 1.6 h (P < 0.0001) in the RMC but not in the UC group. Nights with >4h CPAP use also significantly increased from 9.4 ± 7.7 to 17.7 ± 8.9 (P < 0.0001) in the RMC group but not in the UC group. The percentage of patients with an improvement in adherence after 12 months was 34.2 % RMC vs 16.4 % UC, P < 0.05. Patients whose adherence worsened were 11.8 % RMC and 19.3 % UC (P < 0.05). None of the patients followed at a distance required face-to-face visit for the duration of the study. Conclusion: long-term telemedicine follow-up compared to standard care is effective in improving adherence to CPAP in patients with initial CPAP adaptation difficulties. The follow-up by a RMC outside the OU can be considered a safe and effective option to reduce the workload of the staff in the OU.