Patient Engagement Using New Technology to Improve Adherence to Positive Airway Pressure Therapy: A Retrospective Analysis

Overview

Journal Chest

Publisher Elsevier

Specialty Pulmonary Medicine

Date 2017 Nov 21

PMID 29154970

Citations 56

Authors

Atul Malhotra

Maureen E Crocker

Leslee Willes

Colleen Kelly

Sue Lynch

Adam V Benjafield

Affiliations

Soon will be listed here.

Abstract

Background: Sleep apnea has major neurocognitive and cardiovascular and metabolic risks. Treatment of sleep apnea is suboptimal because of variable adherence to existing therapies.

Methods: This trial compared positive airway pressure adherence among patients who were provided active patient engagement (APE) technology vs those who received usual care monitoring (UCM). The primary outcome was expressed by using the US Medicare definition of adherence. Adherence data from two cloud-based databases (AirView and myAir) were analyzed for patients with sleep apnea. Data were included if a patient's activation date in the APE tool was within 7 days of the therapy start date in the UCM database during a defined time window. Data were propensity matched in a 1:2 ratio (APE:UCM) based on baseline patient characteristics.

Results: A total of 128,037 patients were analyzed. Baseline characteristics were typical of a sleep clinic cohort. APE was associated with more patients achieving adherence criteria (87.3%) compared with UCM patients (70.4%; P < .0001 for the difference). Average therapy usage was 5.9 h per night in the APE group vs 4.9 h per night in the matched UCM patients (P < .0001). Patients with sleep apnea "struggling" with therapy adherence had a 17.6% absolute improvement in adherence using APE compared with UCM.

Conclusions: Robust therapy adherence rates can be achieved by adding modern technology to usual care. Adopting advances in technology in care management may allow clinicians to more effectively and efficiently treat patients who have sleep apnea. Rigorous randomized controlled trials may be required before making strong clinical recommendations.

Citing Articles

Digital health delivery in respiratory medicine: adjunct, replacement or cause for division?.

Ottewill C, Gleeson M, Kerr P, Hale E, Costello R Eur Respir Rev. 2024; 33(173).

PMID: 39322260 PMC: 11423130. DOI: 10.1183/16000617.0251-2023.

Novel concept of personalized therapy with continuous positive airway pressure.

Yamauchi M, Moritsuchi Y, Hamada E Sleep Breath. 2024; 28(5):1863-1865.

PMID: 38951384 PMC: 11450021. DOI: 10.1007/s11325-024-03095-0.

Tackling obstructive sleep apnea with pharmacotherapeutics: expert guidance.

Harding C, Fuentes A, Malhotra A Expert Opin Pharmacother. 2024; 25(8):1019-1026.

PMID: 38913403 PMC: 11227253. DOI: 10.1080/14656566.2024.2365329.

Weight reduction and the impact on apnea-hypopnea index: A systematic meta-analysis.

Malhotra A, Heilmann C, Banerjee K, Dunn J, Bunck M, Bednarik J Sleep Med. 2024; 121:26-31.

PMID: 38908268 PMC: 11330732. DOI: 10.1016/j.sleep.2024.06.014.

Continuous positive airway pressure is here to stay.

Malhotra A, Pettus J Lancet Respir Med. 2024; 12(7):507-508.

PMID: 38768623 PMC: 11211046. DOI: 10.1016/S2213-2600(23)00469-1.

References

Montesi S, Bakker J, MacDonald M, Hueser L, Pittman S, White D . Air leak during CPAP titration as a risk factor for central apnea. J Clin Sleep Med. 2013; 9(11):1187-91. PMC: 3805805. DOI: 10.5664/jcsm.3166. View

Lin H, Zuliani G, Amjad E, Prasad A, Badr M, Pan C . Treatment compliance in patients lost to follow-up after polysomnography. Otolaryngol Head Neck Surg. 2007; 136(2):236-40. DOI: 10.1016/j.otohns.2006.08.007. View

Hoy C, Vennelle M, Kingshott R, Engleman H, Douglas N . Can intensive support improve continuous positive airway pressure use in patients with the sleep apnea/hypopnea syndrome?. Am J Respir Crit Care Med. 1999; 159(4 Pt 1):1096-100. DOI: 10.1164/ajrccm.159.4.9808008. View

Platt A, Kuna S, Field S, Chen Z, Gupta R, Roche D . Adherence to sleep apnea therapy and use of lipid-lowering drugs: a study of the healthy-user effect. Chest. 2009; 137(1):102-8. PMC: 2803121. DOI: 10.1378/chest.09-0842. View

Weaver T, Grunstein R . Adherence to continuous positive airway pressure therapy: the challenge to effective treatment. Proc Am Thorac Soc. 2008; 5(2):173-8. PMC: 2645251. DOI: 10.1513/pats.200708-119MG. View

Mukherjee S, Patel S, Kales S, Ayas N, Strohl K, Gozal D . An Official American Thoracic Society Statement: The Importance of Healthy Sleep. Recommendations and Future Priorities. Am J Respir Crit Care Med. 2015; 191(12):1450-8. PMC: 5442970. DOI: 10.1164/rccm.201504-0767ST. View

Peker Y, Glantz H, Eulenburg C, Wegscheider K, Herlitz J, Thunstrom E . Effect of Positive Airway Pressure on Cardiovascular Outcomes in Coronary Artery Disease Patients with Nonsleepy Obstructive Sleep Apnea. The RICCADSA Randomized Controlled Trial. Am J Respir Crit Care Med. 2016; 194(5):613-20. DOI: 10.1164/rccm.201601-0088OC. View

Schwab R, Badr S, Epstein L, Gay P, Gozal D, Kohler M . An official American Thoracic Society statement: continuous positive airway pressure adherence tracking systems. The optimal monitoring strategies and outcome measures in adults. Am J Respir Crit Care Med. 2013; 188(5):613-20. PMC: 5447296. DOI: 10.1164/rccm.201307-1282ST. View

Gulati A, Ali M, Davies M, Quinnell T, Smith I . A prospective observational study to evaluate the effect of social and personality factors on continuous positive airway pressure (CPAP) compliance in obstructive sleep apnoea syndrome. BMC Pulm Med. 2017; 17(1):56. PMC: 5361817. DOI: 10.1186/s12890-017-0393-7. View

10.

Wimms A, Richards G, Benjafield A . Assessment of the impact on compliance of a new CPAP system in obstructive sleep apnea. Sleep Breath. 2012; 17(1):69-76. PMC: 3575556. DOI: 10.1007/s11325-012-0651-0. View

11.

Haniffa M, Lasserson T, Smith I . Interventions to improve compliance with continuous positive airway pressure for obstructive sleep apnoea. Cochrane Database Syst Rev. 2004; (4):CD003531. DOI: 10.1002/14651858.CD003531.pub2. View

12.

Putcha N, Crainiceanu C, Norato G, Samet J, Quan S, Gottlieb D . Influence of Lung Function and Sleep-disordered Breathing on All-Cause Mortality. A Community-based Study. Am J Respir Crit Care Med. 2016; 194(8):1007-1014. PMC: 5067819. DOI: 10.1164/rccm.201511-2178OC. View

13.

Valentin A, Subramanian S, Quan S, Berry R, Parthasarathy S . Air leak is associated with poor adherence to autoPAP therapy. Sleep. 2011; 34(6):801-6. PMC: 3098948. DOI: 10.5665/SLEEP.1054. View

14.

Aloia M, Stanchina M, Arnedt J, Malhotra A, Millman R . Treatment adherence and outcomes in flexible vs standard continuous positive airway pressure therapy. Chest. 2005; 127(6):2085-93. PMC: 2287195. DOI: 10.1378/chest.127.6.2085. View

15.

Kim J, Wineinger N, Steinhubl S . The Influence of Wireless Self-Monitoring Program on the Relationship Between Patient Activation and Health Behaviors, Medication Adherence, and Blood Pressure Levels in Hypertensive Patients: A Substudy of a Randomized Controlled Trial. J Med Internet Res. 2016; 18(6):e116. PMC: 4935792. DOI: 10.2196/jmir.5429. View

16.

Fox N, Hirsch-Allen A, Goodfellow E, Wenner J, Fleetham J, Ryan C . The impact of a telemedicine monitoring system on positive airway pressure adherence in patients with obstructive sleep apnea: a randomized controlled trial. Sleep. 2012; 35(4):477-81. PMC: 3296789. DOI: 10.5665/sleep.1728. View

17.

Phillips B, Gozal D, Malhotra A . What Is the Future of Sleep Medicine in the United States?. Am J Respir Crit Care Med. 2015; 192(8):915-7. DOI: 10.1164/rccm.201508-1544ED. View

18.

Bakker J, Edwards B, Gautam S, Montesi S, Duran-Cantolla J, Aizpuru F . Blood pressure improvement with continuous positive airway pressure is independent of obstructive sleep apnea severity. J Clin Sleep Med. 2014; 10(4):365-9. PMC: 3960377. DOI: 10.5664/jcsm.3604. View

19.

Deacon N, Jen R, Li Y, Malhotra A . Treatment of Obstructive Sleep Apnea. Prospects for Personalized Combined Modality Therapy. Ann Am Thorac Soc. 2015; 13(1):101-8. PMC: 5461982. DOI: 10.1513/AnnalsATS.201508-537FR. View

20.

Weaver T, Mancini C, Maislin G, Cater J, Staley B, Landis J . Continuous positive airway pressure treatment of sleepy patients with milder obstructive sleep apnea: results of the CPAP Apnea Trial North American Program (CATNAP) randomized clinical trial. Am J Respir Crit Care Med. 2012; 186(7):677-83. PMC: 3480519. DOI: 10.1164/rccm.201202-0200OC. View