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. 2023 Jun 7:5:1043578.
doi: 10.3389/fdgth.2023.1043578. eCollection 2023.

Pilot study of positive airway pressure usage, patient journey and program engagement for users of a digital obstructive sleep apnea program

Shefali Kumar  1 , Emma Rudie  1 , Cynthia Dorsey  1 , Kimberly Caswell  1 , Amy Blase  2 , Fatima Sert Kuniyoshi  2 , Adam V Benjafield  2 , Shannon S Sullivan  1
Affiliations

Pilot study of positive airway pressure usage, patient journey and program engagement for users of a digital obstructive sleep apnea program

Shefali Kumar et al. Front Digit Health. .

Abstract

Purpose: This single-arm, decentralized pilot study assessed patient journey, positive airway pressure (PAP) usage and program satisfaction for users of an entirely virtual telemedicine program for obstructive sleep apnea (OSA) diagnosis and management. This analysis focuses specifically on the subset of participants in the program who were diagnosed with OSA and prescribed PAP therapy.

Methods: The Verily Clinical Studies Platform was used for virtual screening, consent, and enrolling eligible patients from North Carolina and Texas. After completing the virtual OSA diagnosis process, participants diagnosed with OSA and prescribed PAP therapy downloaded the program's mobile app. The app featured tools such as educational content, live coaching support, and motivational enhancement.

Results: Of the patients included in this analysis (N = 105), the majority were female (58%), and white (90%). The mean time from first televisit to PAP initiation was 29.2 (SD 12.8) days and f 68 out of the 105 patients (65%) reached 90-day adherence. On average, patients used their PAP device for 4.4 h per day, and 5.4 h on days used. Engagement with the app was associated with higher rates of PAP adherence. Adherent individuals used the mobile app 52 out of the 90 days on average, compared to non-adherent individuals who used the app on 35 out of the 90 days on average (p = 0.0003).

Conclusions: All of the 105 patients in this program diagnosed with OSA and prescribed PAP therapy were able to efficiently complete the entire OSA diagnostic pathway. The majority of these individuals also were able to adhere to their prescribed PAP therapy and had clinically meaningful PAP usage rates over the 90 days of therapy. Future studies might further evaluate the impact of this type of end-to-end virtual program on longer-term adherence and clinical outcomes over time.

Clinical trial registration: https://clinicaltrials.gov/ct2/show/NCT04599803?term=NCT04599803&draw=2&rank=1, identifier NCT04599803.

Keywords: PAP; obstructive sleep apnea management; positive airway pressure; remote care pathway; telemedicine.

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Conflict of interest statement

SK, ER, CD, KC, and SS report employment and equity ownership in Verily Life Sciences. SS and CD were consultants for Verily Life Sciences on this project. AB, FSK, and AVB report employment at ResMed Inc.

Figures

Figure 1
Figure 1
Consort diagram showing number of participants reaching each stage of the program.
Figure 2
Figure 2
Average PAP use vs. Total days of app use.
Figure 3
Figure 3
Average PAP use per participant by week of therapy, (A) adherent vs. Non-adherent, (B) by coach use (‘use’ defined as >3 messages sent by participant).
Figure 4
Figure 4
Average hours of nightly PAP use, (A) stratified by presence of selected comorbidities, (B) stratified by baseline characteristics.
See this image and copyright information in PMC

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