Continuous positive airway pressure (CPAP) is the standard treatment
for the obstructive sleep apnea syndrome (OSAS), but long-term
adherence remains a challenge. In a pilot study, we observed that
telemedicine combined with telemetrically-triggered interventions
was associated with improved CPAP adherence in the first month of
In the current randomized, controlled phase III trial, we aimed at
collecting pivotal data for the use of telemedicine in CPAP
treatment of patients with OSAS.
Symptomatic OSAS patients were randomized to a telemedicine or
control arm and initiated CPAP treatment. Phone calls were triggered
in the telemedicine group during the first month of treatment either
upon poor usage or excessive mask leakage. Patients were followed
for 6 months. Measures of CPAP usage at 6 months were the main study
Among 240 patients enrolled, 71 (30%) discontinued CPAP treatment
over the course of the study. The primary outcome measure, the
proportion of nights with CPAP usage ≥1 h, was not statistically
different in the telemedicine (92.0%) versus the control group
(88.2%) (p=0.565). The daily hours of CPAP usage at 6 months also
did not differ significantly between the telemedicine (5.6 h) and
the control group (4.8 h) (p=0.663). However, in a post-hoc
analysis, telemedicine led to increased device usage in a subgroup
of patients with a mild form of disease (5.6 h versus 3.4 h,
p=0.026). The telemedicine-based intervention had a positive impact
on sleep-related quality of life, as measured with Quebec Sleep
Questionnaire (5.55 versus 5.49 at 1 month, p=0.020; 5.61 vs 5.46 at
6 months, p=0.013).
A telemetrically-triggered intervention in the first month of
treatment did not improve CPAP usage in the study population
overall, yet had positive effects in patients with a mild form of
OSAS and led to an improvement in sleep-related quality of life.
Clinical trial registered with ClinicalTrial.gov (NCT01715194).