Aardoom Jiska Joëlle, Loheide-Niesmann Lisa, Ossebaard Hans C, Riper Heleen
Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit, Amsterdam, Netherlands.
Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands.
J Med Internet Res. 2020 Feb 18;22(2):e16972. doi: 10.2196/16972.
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.
This meta-analytic review was designed to investigate the effectiveness of a broad range of eHealth interventions in improving CPAP treatment adherence.
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.
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.
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.
阻塞性睡眠呼吸暂停（OSA）成年患者对持续气道正压通气（CPAP）治疗的依从性差是一个常见问题。通过信息和通信技术（即电子健康）实施的策略可以通过患者教育、日常生活中呼吸暂停症状和CPAP依从性的实时监测、自我管理以及在设备或治疗出现问题时的早期识别和后续干预来解决治疗依从性问题。然而，现有电子健康技术在提高CPAP依从性方面的有效性尚未得到系统研究。
本荟萃分析旨在研究广泛的电子健康干预措施在提高CPAP治疗依从性方面的有效性。
我们对Cochrane图书馆、PsycINFO、PubMed和Embase数据库进行了系统的文献检索，以确定成年OSA人群中的相关随机对照试验。使用Cochrane协作偏倚风险工具的七个项目检查纳入研究中的偏倚风险。使用综合荟萃分析软件进行荟萃分析，该软件计算干预后平均依从性的差异（MD），MD定义为每晚使用CPAP的平均小时数。
荟萃分析最终纳入了18项研究（N = 5429名成年OSA患者），包括22组实验条件与对照条件的比较。干预后数据在基线后1至6个月进行评估，具体取决于实验干预的时长。与常规护理相比，电子健康干预增加了每晚CPAP的平均使用时长（MD = 0.54，95%CI 0.29 - 0.79）。亚组分析未发现将电子健康作为常规护理的附加或替代措施的研究之间（P = 0.95）、评估独立电子健康和将电子健康与面对面护理相结合的混合策略的研究之间（P = 0.23），或全自动干预和指导性电子健康干预的研究之间（P = 0.83）在效果上存在显著差异。由于可用研究稀缺且结果不一，电子健康依从性干预长期随访有效性的证据仍不明确。
针对成年OSA患者的电子健康干预可以在治疗开始后的最初几个月提高对CPAP的依从性，使每晚平均使用时长增加约半小时。关于医疗保健提供者可以最有效实施的电子健康干预的时间、持续时间、强度和具体类型，仍然存在不确定性。
