Tele-monitoring system implementation in continuous positive airway pressure therapy in Asian obstructive sleep apnea

Abstract

Background: Tele-monitoring system is the promising wireless technology which possibly enhances the adherence to CPAP therapy, since the efficacy of CPAP in reducing OSA-related cardiovascular events is proportionally related to the adherence. Methods: A prospective randomized controlled trial enrolled 60 Asian adults with moderate-to-severe OSA. Thirty patients each were randomized to CPAP with tele-monitoring system (TM group) or CPAP with usual care (UC group). Tele-monitoring system functions by transferring CPAP-usage data via cellular network. If there were any triggers occurring 2 nights consecutively (use hour 27 L/min or AHI>5/hr), the investigator contacted patients. The primary outcome was the 4-week CPAP usage hour per night. The secondary outcome included % good adherence, median leakage per night, adverse events from CPAP therapy, sleep quality improvement and daytime sleepiness reduction. Results: Seventy percent of participants were male and average AHI was 50.3/hr. The 4-week CPAP usage hour per night was insignificantly higher in TM group (5.16 ±1.47 hr/night vs 4.42 ±1.91 hr/night, p-value = 0.18). However, % good adherence was significantly higher in TM group (64.2% vs 34.4%, p-value = 0.0024). Median leakage per night was also significant lower in TM group. Significant sleep quality improvement was observed in TM group. Overall adverse events and daytime sleepiness reduction were not significantly different. Conclusion: The tele-monitoring system implementation in CPAP insignificantly increased the nightly hour usage and significantly improved adherence as well as sleep quality among Asian moderate-to-severe OSA.