Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2020 Feb 18;22(2):e16972.
doi: 10.2196/16972.

Effectiveness of eHealth Interventions in Improving Treatment Adherence for Adults With Obstructive Sleep Apnea: Meta-Analytic Review

Jiska Joëlle Aardoom  1   2   3 , Lisa Loheide-Niesmann  1   4 , Hans C Ossebaard  5   6 , Heleen Riper  1   7   8
Affiliations
Review

Effectiveness of eHealth Interventions in Improving Treatment Adherence for Adults With Obstructive Sleep Apnea: Meta-Analytic Review

Jiska Joëlle Aardoom et al. J Med Internet Res. .

Abstract

Background: Poor adherence to continuous positive airway pressure (CPAP) treatment by adults with obstructive sleep apnea (OSA) is a common issue. Strategies delivered by means of information and communication technologies (ie, eHealth) can address treatment adherence through patient education, real-time monitoring of apnea symptoms and CPAP adherence in daily life, self-management, and early identification and subsequent intervention when device or treatment problems arise. However, the effectiveness of available eHealth technologies in improving CPAP adherence has not yet been systematically studied.

Objective: This meta-analytic review was designed to investigate the effectiveness of a broad range of eHealth interventions in improving CPAP treatment adherence.

Methods: We conducted a systematic literature search of the databases of Cochrane Library, PsycINFO, PubMed, and Embase to identify relevant randomized controlled trials in adult OSA populations. The risk of bias in included studies was examined using seven items of the Cochrane Collaboration risk-of-bias tool. The meta-analysis was conducted with comprehensive meta-analysis software that computed differences in mean postintervention adherence (MD), which was defined as the average number of nightly hours of CPAP use.

Results: The meta-analysis ultimately included 18 studies (N=5429 adults with OSA) comprising 22 comparisons between experimental and control conditions. Postintervention data were assessed at 1 to 6 months after baseline, depending on the length of the experimental intervention. eHealth interventions increased the average nightly use of CPAP in hours as compared with care as usual (MD=0.54, 95% CI 0.29-0.79). Subgroup analyses did not reveal significant differences in effects between studies that used eHealth as an add-on or as a replacement to care as usual (P=.95), between studies that assessed stand-alone eHealth and blended strategies combining eHealth with face-to-face care (P=.23), or between studies of fully automated interventions and guided eHealth interventions (P=.83). Evidence for the long-term follow-up effectiveness of eHealth adherence interventions remains undecided owing to a scarcity of available studies and their mixed results.

Conclusions: eHealth interventions for adults with OSA can improve adherence to CPAP in the initial months after the start of treatment, increasing the mean nightly duration of use by about half an hour. Uncertainty still exists regarding the timing, duration, intensity, and specific types of eHealth interventions that could be most effectively implemented by health care providers.

Keywords: continuous positive airway pressure; eHealth; meta-analysis; obstructive sleep apnea; patient adherence; systematic review; telemedicine; treatment adherence.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
PRISMA flowchart describing the study identification and selection process.
Figure 2
Figure 2
Risk of bias for each individual study included in this meta-analytic review.
Figure 3
Figure 3
Summary of the risk of bias for all included studies in this meta-analytic review.
Figure 4
Figure 4
Forest plot of intervention effects on adherence as defined as mean nightly continuous positive airway pressure (CPAP) use in hours.
See this image and copyright information in PMC

References

    1. American Academy of Sleep Medicine Task Force Sleep–Related Breathing Disorders in Adults: Recommendations for Syndrome Definition and Measurement Techniques in Clinical Research. Sleep. 1999;22(5):667–689. doi: 10.1093/sleep/22.5.667. - DOI - PubMed
    1. The Dutch College of General Practitioners Dutch College of General Practitioners’ guideline sleep problems and sleeping pills (second revision) [NHG-Standaard Slaapproblemen en slaapmiddelen (tweede herziening)] Huisarts en wetenschap. 2014;57(7):352–361.
    1. International classification of sleep disorders: Diagnostic and coding manual (2nd ed) Westchester, USA: American Academy of Sleep Medicine; 2005.
    1. Senaratna CV, Perret JL, Lodge CJ, Lowe AJ, Campbell BE, Matheson MC, Hamilton GS, Dharmage SC. Prevalence of obstructive sleep apnea in the general population: A systematic review. Sleep Med Rev. 2017 Aug;34:70–81. doi: 10.1016/j.smrv.2016.07.002. - DOI - PubMed
    1. Giles T, Lasserson TJ, Smith BH, White J, Wright J, Cates CJ. Continuous positive airways pressure for obstructive sleep apnoea in adults. Cochrane Database Syst Rev. 2006 Jul 19;(3):CD001106. doi: 10.1002/14651858.CD001106.pub3. - DOI - PubMed