Center for Sleep and Cardiovascular Outcomes Research and.
Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; and.
Ann Am Thorac Soc. 2022 Dec;19(12):2070-2076. doi: 10.1513/AnnalsATS.202204-310OC.
The benefits of continuous positive airway pressure (CPAP) therapy in obstructive sleep apnea are limited by adherence. Telemonitoring and coaching have been demonstrated to increase adherence, but the ideal duration of such support is unclear. To compare the impact of a 12-month versus a 3-month behavioral support program on CPAP adherence. We evaluated real-world CPAP adherence data from all patients initiating CPAP between July 1, 2018, and April 1, 2020, by any durable medical equipment (DME) providers who had used a 12-month commercially available telemonitoring/coaching program (Long Term Adherence Management, Philips Respironics) in this timeframe. Patients receiving either 12 months or 3 months of support (Patient Adherence Management Service) were compared with those initiated on CPAP without support. Mean CPAP adherence was computed monthly over the initial 18 months. Missing usage was imputed as zero use. All analyses were adjusted for age, sex, and DME provider. The nine DME providers using the 12-month telemonitoring/coaching service cared for a total of 26,489 patients (3,264 receiving 12-month support, 15,424 receiving 3-month support, and 7,801 receiving no support) in the timeframe under study. In adjusted analyses, mean CPAP use in the 3-month support group was greater than the no support group in Month 3 (4.6 h vs. 4.3 h; < 0.001) but subsequently, usage declined to match the no support group at both Month 12 and Month 18. In contrast, mean CPAP use was greater in the 12-month support group than in the no support group at Month 3 (4.6 h vs. 4.3 h; < 0.001), Month 12 (4.0 h vs. 3.6 h; < 0.001), and Month 18 (3.3 h vs. 3.2 h; = 0.02). A 3-month telemonitoring/coaching program increases CPAP use in the short term but does not lead to sustained improvements. In contrast, a 12-month program leads to sustained improvements but results still diminish once coaching ceases. Implementation of longer-term telemonitoring and coaching programs may be vital to obtaining long-term benefits from CPAP therapy.
持续气道正压通气（CPAP）治疗阻塞性睡眠呼吸暂停的益处受到依从性的限制。远程监测和指导已被证明可以提高依从性，但这种支持的理想持续时间尚不清楚。比较 12 个月和 3 个月行为支持方案对 CPAP 依从性的影响。我们评估了所有在 2018 年 7 月 1 日至 2020 年 4 月 1 日期间通过任何耐用医疗设备（DME）提供商开始使用 CPAP 的患者的真实世界 CPAP 依从性数据，这些提供商在这段时间内使用了一种 12 个月的商业上可用的远程监测/指导方案（长期依从性管理，飞利浦 Respironics）。比较接受 12 个月或 3 个月支持（患者依从性管理服务）的患者与未接受支持的 CPAP 初始患者。在最初的 18 个月中，每月计算 CPAP 依从性的平均值。缺失的使用量被估计为零使用。所有分析均针对年龄、性别和 DME 提供者进行了调整。在研究期间，使用 12 个月远程监测/指导服务的九个 DME 提供商共照顾了 26489 名患者（3264 名接受 12 个月支持，15424 名接受 3 个月支持，7801 名接受无支持）。在调整后的分析中，在第 3 个月，3 个月支持组的 CPAP 使用量大于无支持组（4.6 小时比 4.3 小时； < 0.001），但随后，在第 12 个月和第 18 个月，使用量与无支持组相匹配。相比之下，在第 3 个月（4.6 小时比 4.3 小时； < 0.001）、第 12 个月（4.0 小时比 3.6 小时； < 0.001）和第 18 个月（3.3 小时比 3.2 小时； = 0.02），12 个月支持组的 CPAP 使用量大于无支持组。为期 3 个月的远程监测/指导方案可在短期内增加 CPAP 的使用量，但不能持续改善。相比之下，为期 12 个月的方案可带来持续改善，但一旦停止指导，效果仍会减弱。实施长期远程监测和指导方案可能对从 CPAP 治疗中获得长期益处至关重要。
