Sleep Disorders Program, University of British Columbia Hospital, Vancouver, British Columbia, Canada.
Sleep. 2012 Apr 1;35(4):477-81. doi: 10.5665/sleep.1728.
First-line therapy for patients with moderate to severe obstructive sleep apnea (OSA) is positive airway pressure (PAP). Although PAP is a highly efficacious treatment, adherence to PAP is still a substantial clinical problem. The objective of this study was to determine whether PAP adherence can be improved with a telemedicine monitoring system.
A nonblinded, single-center, randomized controlled trial that compared standard PAP treatment versus PAP treatment and a telemedicine monitoring system
University sleep disorders program in British Columbia, Canada
Adult patients (≥ 19 yr of age) with moderate to severe OSA (apnea hypopnea index (AHI) ≥ 15 events/hr determined by polysomnography) prescribed PAP INTERVENTIONS: Patients were randomized to either standard care with an autotitrating PAP machine or an autotitrating PAP machine that transmitted physiologic information (i.e., adherence, air leak, residual AHI) daily to a website that could be reviewed. If problems were identified from information from the website, the patient was contacted by telephone as necessary.
PAP adherence after 3 mo, subjective sleep quality, and side effects
Seventy-five patients were enrolled; 39 were randomized to telemedicine and 36 to standard care. The mean age ± standard deviation (SD) was 53.5 ± 11.2 yr, mean AHI was 41.6 ± 22.1 events/hr, and 80% of patients were male. After 3 mo, mean PAP adherence was significantly greater in the telemedicine arm (191 min per day) versus the standard arm (105 min per day; mean difference = 87 min, 95% confidence interval (CI): 25-148 min, P = 0.006, unpaired t test). On days when PAP was used, mean adherence was 321 min in the telemedicine arm and 207 min in the standard arm (difference = 113 min, 95% CI: 62-164 min, P < 0.0001). Significant independent predictors of adherence included age, baseline Epworth Sleepiness Scale score, and use of telemedicine. On average, an additional 67 min of technician time was spent on patients in the telemedicine arm compared with the standard arm (P = 0.0001).
PAP adherence can be improved with the use of a web-based telemedicine system at the initiation of treatment.
中重度阻塞性睡眠呼吸暂停（OSA）患者的一线治疗是正压通气（PAP）。尽管 PAP 是一种非常有效的治疗方法，但患者对 PAP 的依从性仍然是一个重要的临床问题。本研究旨在确定远程医疗监测系统是否能提高 PAP 的依从性。
一项非盲、单中心、随机对照试验，比较标准 PAP 治疗与 PAP 治疗加远程医疗监测系统
加拿大不列颠哥伦比亚大学睡眠障碍计划
成人患者（≥ 19 岁），中重度 OSA（通过多导睡眠图确定的呼吸暂停低通气指数（AHI）≥ 15 次/小时），给予 PAP
患者随机分为标准治疗组（自动滴定 PAP 机）或自动滴定 PAP 机组（每日传送生理信息，如依从性、漏气、残余 AHI）至网站，可进行回顾。如果从网站信息中发现问题，必要时通过电话联系患者。
3 个月后的 PAP 依从性、主观睡眠质量和副作用
共纳入 75 例患者，39 例随机分为远程医疗组，36 例随机分为标准治疗组。平均年龄±标准差（SD）为 53.5±11.2 岁，平均 AHI 为 41.6±22.1 次/小时，80%的患者为男性。3 个月后，远程医疗组的 PAP 依从性显著高于标准组（191 分钟/天），而标准组为 105 分钟/天（平均差异为 87 分钟，95%置信区间（CI）：25-148 分钟，P=0.006，未配对 t 检验）。在使用 PAP 的日子里，远程医疗组的平均依从性为 321 分钟，标准组为 207 分钟（差异为 113 分钟，95%CI：62-164 分钟，P<0.0001）。依从性的独立预测因素包括年龄、基线 Epworth 嗜睡量表评分和远程医疗的使用。与标准组相比，远程医疗组平均多花费 67 分钟的技师时间（P=0.0001）。
在开始治疗时使用基于网络的远程医疗系统可以提高 PAP 的依从性。
