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Clinical Trial
. 2018 Apr;153(4):843-850.
doi: 10.1016/j.chest.2017.11.005. Epub 2017 Nov 15.

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

Atul Malhotra  1 , Maureen E Crocker  2 , Leslee Willes  3 , Colleen Kelly  4 , Sue Lynch  2 , Adam V Benjafield  2
Affiliations
Clinical Trial

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

Atul Malhotra et al. Chest. 2018 Apr.

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.

Keywords: CPAP; OSA; lung; sleep medicine; sleep-disordered breathing.

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Figures

Figure 1
Figure 1
Flow diagram. APE = active patient engagement; UCM = usual care monitoring.
Figure 2
Figure 2
Distribution of mean nightly positive airway pressure usage. See Figure 1 legend for expansion of abbreviations.
Figure 3
Figure 3
Changes in group distribution based on mean nightly PAP usage. The y-axis shows the percentage of patients, and the x-axis displays mean daily PAP usage in hours. The size of each dot is weighted by the number of patients it represents. PAP = positive airway pressure. See Figure 1 legend for expansion of other abbreviations.
See this image and copyright information in PMC

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