Positive Airway Pressure Telehealth Models and Long-term Therapy Termination: a Healthcare Database Analysis

Overview

Journal ERJ Open Res

Specialty Pulmonary Medicine

Date 2024 Feb 27

PMID 38410706

Authors

Holger Woehrle

Christoph Schoebel

Joachim H Ficker

Andrea Graml

Jurgen Schnepf

Ingo Fietze

Peter Young

Michael Arzt

Affiliations

Soon will be listed here.

Abstract

Background: Telemonitoring-guided interventions can improve short-term positive airway pressure (PAP) therapy adherence, but long-term effects are unknown. This study investigated long-term PAP therapy termination in patients with sleep apnoea managed with standard care, telemonitoring-guided proactive care or telemonitoring-guided proactive care + patient engagement tool.

Methods: German healthcare provider data were analysed retrospectively. Individuals aged 18-100 years who started PAP from 2014 to 2019 and had device type/interface data were included. Time-to-termination periods were analysed using Kaplan-Meier plots and Cox proportional hazards regression, adjusted for age, sex, insurance type, and device and mask type.

Results: The per-protocol population (valid telemonitoring data) included 104 612 individuals (71% male; 95% aged >40 years). Mean follow-up was 3.3±2.0 years. The overall therapy termination rate was significantly lower in the telemonitoring-guided proactive care group standard care (20% 27%; p<0.001), and even lower in the telemonitoring-guided care + patient engagement tool group (11%; p<0.001 other treatment groups). Adjusted risk of therapy termination was lower standard care (hazard ratio 0.76, 95% confidence interval 0.74-0.78; and 0.41 (0.38-0.44) for telemonitoring-guided proactive care alone + patient engagement). Age <50 or >59 years and use of a nasal pillows or full-face mask were significant predictors of therapy termination; male sex, use of telemonitoring-guided proactive care (± patient engagement) and private insurance were significantly associated with lower therapy termination rates.

Conclusions: Use of telemonitoring-guided proactive care and a patient engagement tool was associated with lower rates of PAP therapy termination.

References

Patil S, Ayappa I, Caples S, Kimoff R, Patel S, Harrod C . Treatment of Adult Obstructive Sleep Apnea with Positive Airway Pressure: An American Academy of Sleep Medicine Clinical Practice Guideline. J Clin Sleep Med. 2019; 15(2):335-343. PMC: 6374094. DOI: 10.5664/jcsm.7640. View

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

Munafo D, Hevener W, Crocker M, Willes L, Sridasome S, Muhsin M . A telehealth program for CPAP adherence reduces labor and yields similar adherence and efficacy when compared to standard of care. Sleep Breath. 2016; 20(2):777-85. PMC: 4850183. DOI: 10.1007/s11325-015-1298-4. View

Niu Y, Xi H, Zhu R, Guo Y, Wang S, Xiong X . Effects of telemedicine-based follow-up management on adults with obstructive sleep apnea: A systematic review and meta-analysis. Int J Med Inform. 2023; 176:105108. DOI: 10.1016/j.ijmedinf.2023.105108. View

Hwang D, Chang J, Benjafield A, Crocker M, Kelly C, Becker K . Effect of Telemedicine Education and Telemonitoring on Continuous Positive Airway Pressure Adherence. The Tele-OSA Randomized Trial. Am J Respir Crit Care Med. 2017; 197(1):117-126. DOI: 10.1164/rccm.201703-0582OC. View

Aardoom J, Loheide-Niesmann L, Ossebaard H, Riper H . Effectiveness of eHealth Interventions in Improving Treatment Adherence for Adults With Obstructive Sleep Apnea: Meta-Analytic Review. J Med Internet Res. 2020; 22(2):e16972. PMC: 7055847. DOI: 10.2196/16972. View

Sparrow D, Aloia M, Demolles D, Gottlieb D . A telemedicine intervention to improve adherence to continuous positive airway pressure: a randomised controlled trial. Thorax. 2010; 65(12):1061-6. DOI: 10.1136/thx.2009.133215. View

Woehrle H, Arzt M, Graml A, Fietze I, Young P, Teschler H . Effect of a patient engagement tool on positive airway pressure adherence: analysis of a German healthcare provider database. Sleep Med. 2018; 41:20-26. DOI: 10.1016/j.sleep.2017.07.026. View

Woehrle H, Arzt M, Graml A, Fietze I, Young P, Teschler H . Predictors of positive airway pressure therapy termination in the first year: analysis of big data from a German homecare provider. BMC Pulm Med. 2018; 18(1):186. PMC: 6280473. DOI: 10.1186/s12890-018-0748-8. View

10.

Rotenberg B, Murariu D, Pang K . Trends in CPAP adherence over twenty years of data collection: a flattened curve. J Otolaryngol Head Neck Surg. 2016; 45(1):43. PMC: 4992257. DOI: 10.1186/s40463-016-0156-0. View

11.

Salepci B, Caglayan B, Kiral N, Parmaksiz E, Sener Comert S, Sarac G . CPAP adherence of patients with obstructive sleep apnea. Respir Care. 2013; 58(9):1467-73. DOI: 10.4187/respcare.02139. View

12.

McArdle N, Devereux G, Heidarnejad H, Engleman H, Mackay T, Douglas N . Long-term use of CPAP therapy for sleep apnea/hypopnea syndrome. Am J Respir Crit Care Med. 1999; 159(4 Pt 1):1108-14. DOI: 10.1164/ajrccm.159.4.9807111. View

13.

Weaver T, Maislin G, Dinges D, Bloxham T, George C, Greenberg H . Relationship between hours of CPAP use and achieving normal levels of sleepiness and daily functioning. Sleep. 2007; 30(6):711-9. PMC: 1978355. DOI: 10.1093/sleep/30.6.711. View

14.

Mayer G, Arzt M, Braumann B, Ficker J, Fietze I, Frohnhofen H . German S3 Guideline Nonrestorative Sleep/Sleep Disorders, chapter "Sleep-Related Breathing Disorders in Adults," short version: German Sleep Society (Deutsche Gesellschaft für Schlafforschung und Schlafmedizin, DGSM). Somnologie (Berl). 2017; 21(4):290-301. PMC: 5705734. DOI: 10.1007/s11818-017-0136-2. View

15.

Weaver T . Novel Aspects of CPAP Treatment and Interventions to Improve CPAP Adherence. J Clin Med. 2020; 8(12). PMC: 6947399. DOI: 10.3390/jcm8122220. View

16.

Coma-Del-Corral M, Alonso-Alvarez M, Allende M, Cordero J, Ordax E, Masa F . Reliability of telemedicine in the diagnosis and treatment of sleep apnea syndrome. Telemed J E Health. 2012; 19(1):7-12. PMC: 3546414. DOI: 10.1089/tmj.2012.0007. View

17.

Woehrle H, Ficker J, Graml A, Fietze I, Young P, Teschler H . Telemedicine-based proactive patient management during positive airway pressure therapy: Impact on therapy termination rate. Somnologie (Berl). 2017; 21(2):121-127. PMC: 5486580. DOI: 10.1007/s11818-016-0098-9. View

18.

Malhotra A, Crocker M, Willes L, Kelly C, Lynch S, Benjafield A . Patient Engagement Using New Technology to Improve Adherence to Positive Airway Pressure Therapy: A Retrospective Analysis. Chest. 2017; 153(4):843-850. PMC: 5989636. DOI: 10.1016/j.chest.2017.11.005. View

19.

Pepin J, Bailly S, Rinder P, Adler D, Szeftel D, Malhotra A . CPAP Therapy Termination Rates by OSA Phenotype: A French Nationwide Database Analysis. J Clin Med. 2021; 10(5). PMC: 7957656. DOI: 10.3390/jcm10050936. View

20.

Diaz-Abad M, Chatila W, Lammi M, Swift I, DAlonzo G, Krachman S . Determinants of CPAP Adherence in Hispanics with Obstructive Sleep Apnea. Sleep Disord. 2014; 2014:878213. PMC: 3932645. DOI: 10.1155/2014/878213. View