Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Sleep and Breathing
Published in: Sleep and Breathing 4/2021

01-12-2021 | Telemedicine | Sleep Breathing Physiology and Disorders • Review

Effects of telemedicine interventions in improving continuous positive airway pressure adherence in patients with obstructive sleep apnoea: a meta-analysis of randomised controlled trials

Authors: Yuli Hu, Yijia Su, Sanlian Hu, Jun Ma, Zuoyan Zhang, Fang Fang, Jian Guan

Published in: Sleep and Breathing | Issue 4/2021

Login to get access

Abstract

Purpose

This meta-analysis was conducted to assess the effects of telemedicine interventions on continuous positive airway pressure (CPAP) adherence in patients with obstructive sleep apnoea (OSA).

Methods

The PubMed, Cochrane Library, OVID, Web of Science and EBSCO host databases were searched from January 2004 to February 2020 for randomised controlled trials (RCTs) that assessed the effects of telemedicine interventions on CPAP adherence in patients with OSA. The study inclusion criteria were RCTs that compared patients who received telemedicine interventions with a control group and reported a change in CPAP adherence. The primary outcome was the improvement in CPAP adherence.

Results

In total, there were 11 RCTs (n = 1358) with quantitative analyses. Intervention times ranged from 1 to 6 months. Compared to controls, the telemedicine group exhibited better adherence to CPAP therapy (pooled mean difference (MD) = 0.57, 95% CI = 0.33 to 0.80, I2 = 7%, p < 0.00001). We performed sensitivity analyses by the type of telemedicine intervention, comorbidity burden, and OSA severity to explore whether or not their effect sizes may have affected the time of CPAP application. We performed subgroup analyses by follow-up duration, age, and OSA Epworth sleepiness scale (ESS) symptoms to determine if their effect sizes may have affected the time of CPAP application. However, these analyses did not change the statistical significance of the pooled estimate.

Conclusions

The use of telemedicine for up to 6 months may enhance CPAP adherence in patients with OSA, when compared to no intervention. Our study was searched from January 2004 to February 2020 for randomised controlled trials (RCTs) that assessed the effects of telemedicine interventions on CPAP adherence in patients with OSA. Future studies can continue to search for articles after February 2020
Literature
1.
Lévy P, Kohler M, McNicholas WT et al (2015) Obstructive sleep apnoea syndrome. Nat Rev Dis Primers 1:15015 Published 2015 Jun 25PubMed
2.
Jordan AS, Mcsharry DG, Malhotra A (2014) Adult obstructive sleep apnoea. Lancet 383(9918):736–747PubMed
3.
Drager LF, McEvoy RD, Barbe F, Lorenzi-Filho G (2017) Redline S; INCOSACT Initiative (International Collaboration of Sleep Apnea Cardiovascular Trialists). Sleep Apnea and Cardiovascular Disease: Lessons From Recent Trials and Need for Team Science. Circulation. 136(19):1840–1850PubMedPubMedCentral
4.
Watson NF (2016) Health care savings: the economic value of diagnostic and therapeutic care for obstructive sleep apnea. Clin Sleep Med 12(8):1075–1077 Published 2016 Aug 15
5.
Zhang C, Lv J, Zhou J, Su L, Feng L, Ma J, Wang G, Zhang J (2015) The effect of CPAP treatment on EEG of OSAS patients. Sleep Breath 19(4):1121–1124PubMed
6.
Patel SR, White DP, Malhotra A, Stanchina ML, Ayas NT (2003) Continuous positive airway pressure therapy for treating sleepiness in a diverse population with obstructive sleep apnea: results of a meta-analysis. Arch Intern Med 163(5):565–571PubMed
7.
Hussain SF, Irfan M, Waheed Z, Alam N, Mansoor S, Islam M (2014) Compliance with continuous positive airway pressure (CPAP) therapy for obstructive sleep apnea among privately paying patients- a cross sectional study. BMC Pulm Med 14:188 Published 2014 Nov 29PubMedPubMedCentral
8.
Marin JM, Carrizo SJ, Vicente E, Agusti AG (2005) Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet. 365(9464):1046–1053PubMed
9.
Kribbs NB, Pack AI, Kline LR, Smith PL, Schwartz AR, Schubert NM, Redline S, Henry JN, Getsy JE, Dinges DF (1993) Objective measurement of patterns of nasal CPAP use by patients with obstructive sleep apnea. Am Rev Respir Dis 147(4):887–895PubMed
10.
11.
Wolkove N, Baltzan M, Kamel H, Dabrusin R, Palayew M (2008) Long-term compliance with continuous positive airway pressure in patients with obstructive sleep apnea. Can Respir J 15(7):365–369PubMedPubMedCentral
12.
Rosen CL, Auckley D, Benca R, Foldvary-Schaefer N, Iber C, Kapur V, Rueschman M, Zee P, Redline S (2012) A multisite randomized trial of portable sleep studies and positive airway pressure autotitration versus laboratory-based polysomnography for the diagnosis and treatment of obstructive sleep apnea: the HomePAP study. Sleep. 35(6):757–767PubMedPubMedCentral
13.
Yuli H, Xiaohong W, Feifei W et al (2019) Effect of telemedicine intervention on hypoglycaemia in diabetes patients: a systematic review and meta-analysis of randomised controlled trials. J Telemed Telecare 25(7):402–413
14.
Fukuoka Y, Gay CL, Joiner KL, Vittinghoff E (2015) A novel diabetes prevention intervention using a mobile app: a randomized controlled trial with overweight adults at risk. Am J Prev Med 49(2):223–237PubMedPubMedCentral
15.
Organization W. H (2010) Telemedicine: opportunities and developments in member states. Report on the second global survey on eHealth. Geneva Switzerland Who
16.
Isetta V, Torres M, Gonzalez K et al (2017) A New mHealth application to support treatment of sleep apnoea patients. J Telemed Telecare 23(1):14–18PubMed
17.
Hostler JM, Sheikh KL, Andrada TF, Khramtsov A, Holley PR, Holley AB (2017) A mobile, web-based system can improve positive airway pressure adherence. J Sleep Res 26(2):139–146PubMed
18.
19.
Sparrow D, Aloia M, Demolles DA et al (2010) A telemedicine intervention to improve adherence to continuous positive airway pressure: a randomised controlled trial. Thorax 65(12):1061–1066PubMed
20.
Smith CE, Dauz ER, Clements F, Puno FN, Cook D, Doolittle G, Leeds W (2006) Telehealth services to improve nonadherence: a placebo-controlled study. Telemed e-Health 12(3):289–296
21.
Anttalainen U, Melkko S, Hakko S, Laitinen T, Saaresranta T (2016) Telemonitoring of CPAP therapy may save nursing time. Sleep Breath 20(4):1209–1215PubMed
22.
Chen L, Chapman JL, Yee BJ, Wong KKH, Grunstein RR, Marshall NS, Miller CB (2018) Agreement between electronic and paper Epworth sleepiness scale responses in obstructive sleep apnoea: secondary analysis of a randomised controlled trial undertaken in a specialised tertiary care clinic. BMJ Open 8(3):e019255PubMedPubMedCentral
23.
Schoch OD, Baty F, Boesch M, Benz G, Niedermann J, Brutsche MH (2019) Telemedicine for continuous positive airway pressure in sleep apnea. A Randomized, Controlled Study. Ann Am Thorac Soc 16(12):1550–1557PubMed
24.
25.
Higgins J, Green SE (2011) Cochrane handbook for systematic reviews of interventions version 5.1.0. Cochrane Collab 2011(14):S38
26.
Hwang D, Chang J W, Benjafield AV, et al (2017) Effect of telemedicine education and telemonitoring on CPAP adherence: the Tele-OSA randomized trial. Am J Respir Crit Care Med rccm.201703-0582OC
27.
Turino C, De Batlle J, Woehrle H et al (2017) Management of continuous positive airway pressure treatment compliance using telemonitoring in obstructive sleep apnoea. Eur Respir J 49(2):1601128PubMed
28.
Stepnowsky CJ, Palau JJ, Marler MR, Gifford AL (2007) Pilot randomized trial of the effect of wireless telemonitoring on compliance and treatment efficacy in obstructive sleep apnea. J Med Internet Res 9(2):e14PubMedPubMedCentral
29.
Taylor Y, Eliasson A, Andrada T, Kristo D, Howard R (2006) The role of telemedicine in CPAP compliance for patients with obstructive sleep apnea syndrome. Sleep Breath 10(3):132–138PubMed
30.
Fox N, Hirschallen A, Goodfellow E et al (2012) The impact of a telemedicine monitoring system on positive airway pressure adherence in patients with obstructive sleep apnea: a randomized controlled trial. Sleep 35(4):477–481PubMedPubMedCentral
31.
Demolles DA, Sparrow D, Friedman GR (2004) A pilot trial of a telecommunications system in sleep apnea management. Med Care 42(8):764–769PubMed
32.
Isetta V (2015) Negrín, Miguel A, Monasterio C, et al. A Bayesian cost-effectiveness analysis of a telemedicine-based strategy for the management of sleep apnoea: a multicentre randomised controlled trial. Thorax 70(11):1054–1061PubMed
33.
Hoet F, Libert W, Sanida C, van den Broecke S, Bruyneel AV, Bruyneel M (2017) Telemonitoring in continuous positive airway pressure-treated patients improves delay to first intervention and early compliance: a randomized trial. Sleep Med 39:77–83PubMed
34.
Stepnowsky C, Edwards C, Zamora T, Barker R, Agha Z (2013) Patient perspective on use of an interactive website for sleep apnea. Int J Telemed Appl 2013:1–10
35.
Munafo D, Hevener W, Crocker M, Willes L, Sridasome S, Muhsin M’ (2016) A telehealth program for CPAP adherence reduces labor and yields similar adherence and efficacy when compared to standard of care. Sleep Breath 20(2):777–785PubMedPubMedCentral
36.
Pépin JL, Jullian-Desayes I, Sapène M, Treptow E, Joyeux-Faure M, Benmerad M, Bailly S, Grillet Y, Stach B, Richard P, Lévy P, Muir JF, Tamisier R (2019) Multimodal remote monitoring of high cardiovascular risk patients with OSA initiating CPAP: a randomized trial. Chest. 155(4):730–739PubMed
37.
Qaseem A, Holty JE, Owens DK, Dallas P, Starkey M, Shekelle P, Clinical Guidelines Committee of the American College of Physicians (2013) Clinical guidelines committee of the American College of Physicians. Management of obstructive sleep apnea in adults: A clinical practice guideline from the American College of Physicians. Ann Intern Med 159(7):471–483PubMed
38.
Weaver TE, Sawyer AM (2010) Adherence to continuous positive airway pressure treatment for obstructive sleep apnoea: implications for future interventions. Indian J Med Res 131:245–258PubMed
39.
Mehrtash M, Bakker JP, Ayas N (2019) Predictors of continuous positive airway pressure adherence in patients with obstructive sleep apnea. Lung 197(2):115–121PubMed
40.
Crawford MR, Espie CA, Bartlett DJ, Grunstein RR (2014) Integrating psychology and medicine in CPAP adherence-new concepts? Sleep Med Rev 18(2):123–139PubMed
41.
Sawyer AM, Gooneratne NS, Marcus CL, Ofer D, Richards KC, Weaver TE (2011) A systematic review of CPAP adherence across age groups: clinical and empiric insights for developing CPAP adherence interventions. Sleep Med Rev 15(6):343–356PubMedPubMedCentral
42.
Gentina T, Bailly S, Jounieaux F, Verkindre C, Broussier PM, Guffroy D, Prigent A, Gres JJ, Kabbani J, Kedziora L, Tamisier R, Gentina E, Pépin JL (2019) Marital quality, partner’s engagement and continuous positive airway pressure adherence in obstructive sleep apnea. Sleep Med 55:56–61PubMed
43.
Parthasarathy S, Wendel C, Haynes PL, Atwood C, Kuna S (2013) A pilot study of CPAP adherence promotion by peer buddies with sleep apnea. J Clin Sleep Med 9(6):543–550PubMedPubMedCentral
44.
Randerath WJ, Verbraecken J, Andreas S, Bettega G, Boudewyns A, Hamans E, Jalbert F, Paoli JR, Sanner B, Smith I, Stuck BA, Lacassagne L, Marklund M, Maurer JT, Pepin JL, Valipour A, Verse T, Fietze I, the European Respiratory Society task force on non-CPAP therapies in sleep apnoea (2011) Non-CPAP therapies in obstructive sleep apnoea. Eur Respir J 37(5):1000–1028PubMed
45.
Yang MC, Huang YC, Lan CC, Wu YK, Huang KF (2015) Beneficial effects of long-term CPAP treatment on sleep quality and blood pressure in adherent subjects with obstructive sleep apnea. Respir Care 60(12):1810–1818PubMed
46.
Marin JM, Agusti A, Villar I, Forner M, Nieto D, Carrizo SJ, Barbé F, Vicente E, Wei Y, Nieto FJ, Jelic S (2012) Association between treated and untreated obstructive sleep apnea and risk of hypertension. JAMA. 307(20):2169–2176PubMedPubMedCentral
47.
Sullivan CE, Issa FG, Berthon-Jones M, Eves L (1981) Reversal of obstructive sleep apnoea by continuous positive airway pressure applied through the nares. Lancet. 1(8225):862–865PubMed
48.
Peker Y, Glantz H, Eulenburg C, Wegscheider K, Herlitz J, Thunström E (2016) 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 194(5):613–620PubMed
49.
Palm A, Berne C, Igelström H et al (2018) The impact of continuous positive airway pressure on circulating igf-1 in patients with obstructive sleep apnea. J Clin Sleep Med 14(3):385–391 Published 2018 Mar 15PubMedPubMedCentral
50.
Shaughnessy GF, Morgenthaler TI (2019) The effect of patient-facing applications on positive airway pressure therapy adherence: a systematic review. J Clin Sleep Med 15(5):769–777 Published 2019 February 15PubMedPubMedCentral
51.
Murphie P, Little S, McKinstry B, Pinnock H (2019) Remote consulting with telemonitoring of continuous positive airway pressure usage data for the routine review of people with obstructive sleep apnoea hypopnoea syndrome: A systematic review. J Telemed Telecare 25(1):17–25PubMed
52.
Wood L, Egger M, Gluud LL, Schulz KF, Jüni P, Altman DG, Gluud C, Martin RM, Wood AJG, Sterne JAC (2008) Empirical evidence of bias in treatment effect estimates in controlled trials with different interventions and outcomes: meta-epidemiological study. BMJ 336(7644):601–605PubMedPubMedCentral
Metadata
Title
Effects of telemedicine interventions in improving continuous positive airway pressure adherence in patients with obstructive sleep apnoea: a meta-analysis of randomised controlled trials
Authors
Yuli Hu
Yijia Su
Sanlian Hu
Jun Ma
Zuoyan Zhang
Fang Fang
Jian Guan
Publication date
01-12-2021
Publisher
Springer International Publishing
Keyword
Telemedicine
Published in
Sleep and Breathing / Issue 4/2021
Print ISSN: 1520-9512
Electronic ISSN: 1522-1709
DOI
https://doi.org/10.1007/s11325-021-02292-5

Other articles of this Issue 4/2021

Sleep and Breathing 4/2021 Go to the issue

Psychiatrics • Original Article

Differential relationship of two measures of sleepiness with the drives for sleep and wake

Sleep Breathing Physiology and Disorders • Review

Association between obstructive sleep apnea and health-related quality of life in untreated adults: a systematic review

Basic Science • Original Article

Comparing the effects of supplemental oxygen therapy and continuous positive airway pressure on patients with obstructive sleep apnea: a meta-analysis of randomized controlled trials

Sleep Breathing Physiology and Disorders • Letter to the Editors

Obstructive sleep apnea and risk of COVID-19 infection, hospitalization and respiratory failure

Sleep Breathing Physiology and Disorders • Review

Socioeconomic disparities in obstructive sleep apnea: a systematic review of empirical research

Sleep Breathing Physiology and Disorders • Original Article

Levels of trace blood elements associated with severe sleep disturbance in maintenance hemodialysis patients

ACC 2024 Congress Coverage

Heart Failure Video

Year in Review: Heart failure and cardiomyopathies

Watch now

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits