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Pressure adjustment is the most useful intervention for improving compliance in telemonitored patients treated with CPAP in the first 6 months of treatment

  • Sleep Breathing Physiology and Disorders • Original Article
  • Published:
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Abstract

Purpose

Telemonitoring (TMg) for patients treated with continuous positive airway pressure (CPAP) is now routine care in some sleep labs. The purpose of the present study was to identify technical interventions associated with improved CPAP compliance in a real-life cohort of newly telemonitored patients with obstructive sleep apnea (OSA) during the first 6 months of treatment.

Methods

All patients with moderate-to-severe OSA (apnea-hypopnea index (AHI) ≥ 15/h) who were newly treated with CPAP were included in the study and telemonitored. A group educational session was scheduled after 1 month. Technical interventions were performed at the patient’s request and during scheduled visits and the impact of each intervention on CPAP therapy compliance was collected.

Results

Between May 2018 and Dec 2019, 349 patients newly diagnosed with OSA were hospitalized in the sleep lab for CPAP titration and 212 patients were included (mean age 54.6 ± 13.1 years, mean BMI 31.7 ± 5.8 kg/m2, mean AHI 42.8 ± 22.0). TMg acceptance rate was 87%. Mean 6-month compliance was 275 ± 154 min, 13% stopped CPAP, and 17% were non-compliant. Correlations were observed between BMI (r = 0.15, p = 0.029), median and 95th percentile leaks (r = −0.23 and −0.18, p = 0.016 and 0.002), and CPAP compliance.

During follow-up, 92 interventions were required, mainly for mask change (n = 80). Pressure modification (n = 16) was the only intervention that increased CPAP use > 30 min/night, p = 0.021.

Conclusion

Pressure modification was the only adaptation that significantly increased CPAP compliance during the first 6 months. Remote TMg allows providing daily, accurate, and immediate feedback that could help clinicians to confirm that the CPAP treatment is effective.

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Data availability

The data are available on request addressed to the corresponding author.

References

  1. Marin JM, Carrizo SJ, Vicente E, Agusti AG (2005) Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet 365(9464):1046–1053. https://doi.org/10.1016/S0140-6736(05)71141-7

    Article  PubMed  Google Scholar 

  2. Silva GE, An MW, Goodwin JL, Shahar E, Redline S, Resnick H, Baldwin CM, Quan SF (2009) Longitudinal evaluation of sleep-disordered breathing and sleep symptoms with change in quality of life: the Sleep Heart Health Study (SHHS). Sleep 32(8):1049–1057. https://doi.org/10.1093/sleep/32.8.1049 PMID: 19725256; PMCID: PMC2717195.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Kribbs NB, Pack AI, Kline LR, Getsy JE, Schuett JS, Henry JN, Maislin G, Dinges DF (1993) Effects of one night without nasal CPAP treatment on sleep and sleepiness in patients with obstructive sleep apnea. Am Rev Respir Dis 147(5):1162–1168. https://doi.org/10.1164/ajrccm/147.5.1162

    Article  CAS  PubMed  Google Scholar 

  4. Barbé F, Durán-Cantolla J, Capote F, de la Peña M, Chiner E, Masa JF, Gonzalez M, Marín JM, Garcia-Rio F, de Atauri JD, Terán J, Mayos M, Monasterio C, del Campo F, Gomez S, de la Torre MS, Martinez M, Montserrat JM, Spanish Sleep and Breathing Group (2010) Long-term effect of continuous positive airway pressure in hypertensive patients with sleep apnea. Am J Respir Crit Care Med 181(7):718–726. https://doi.org/10.1164/rccm.200901-0050OC Epub 2009 Dec 10

    Article  PubMed  Google Scholar 

  5. Bouloukaki I, Giannadaki K, Mermigkis C, Tzanakis N, Mauroudi E, Moniaki V, Michelakis S, Siafakas NM, Schiza SE (2014) Intensive versus standard follow-up to improve continuous positive airway pressure compliance. Eur Respir J 44(5):1262–1274. https://doi.org/10.1183/09031936.00021314 Epub 2014 Jul 3

    Article  PubMed  Google Scholar 

  6. Chai-Coetzer CL, Luo YM, Antic NA, Zhang XL, Chen BY, He QY, Heeley E, Huang SG, Anderson C, Zhong NS, McEvoy RD (2013) Predictors of long-term adherence to continuous positive airway pressure therapy in patients with obstructive sleep apnea and cardiovascular disease in the SAVE study. Sleep 36(12):1929–1937. https://doi.org/10.5665/sleep.3232 PMID: 24293768; PMCID: PMC3825443.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Borel JC, Tamisier R, Dias-Domingos S, Sapene M, Martin F, Stach B, Grillet Y, Muir JF, Levy P, Series F, Pepin JL, Scientific Council of The Sleep Registry of the French Federation of Pneumology (OSFP) (2013) Type of mask may impact on continuous positive airway pressure adherence in apneic patients. PLoS One 8(5):e64382. https://doi.org/10.1371/journal.pone.0064382 PMID: 23691209; PMCID: PMC3654912.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Van Ryswyk E, Anderson CS, Antic NA, Barbe F, Bittencourt L, Freed R, Heeley E, Liu Z, Loffler KA, Lorenzi-Filho G, Luo Y, Margalef MJM, McEvoy RD, Mediano O, Mukherjee S, Ou Q, Woodman R, Zhang X, Chai-Coetzer CL (2019) Predictors of long-term adherence to continuous positive airway pressure in patients with obstructive sleep apnea and cardiovascular disease. Sleep 42(10):zsz152. https://doi.org/10.1093/sleep/zsz152

    Article  PubMed  Google Scholar 

  9. Bakker JP, Weaver TE, Parthasarathy S, Aloia MS (2019) Adherence to CPAP: what should we be aiming for, and how can we get there? Chest 155(6):1272–1287. https://doi.org/10.1016/j.chest.2019.01.012 Epub 2019 Jan 23

    Article  PubMed  Google Scholar 

  10. Weaver TE (2019) Novel aspects of CPAP treatment and interventions to improve CPAP adherence. J Clin Med 8(12):2220. https://doi.org/10.3390/jcm8122220 PMID: 31888148; PMCID: PMC6947399.

    Article  PubMed Central  Google Scholar 

  11. Jurado-Gamez B, Bardwell WA, Cordova-Pacheco LJ, García-Amores M, Feu-Collado N, Buela-Casal G (2015) A basic intervention improves CPAP adherence in sleep apnoea patients: a controlled trial. Sleep Breath 19(2):509–514. https://doi.org/10.1007/s11325-014-1038-1 Epub 2014 Jul 25

    Article  CAS  PubMed  Google Scholar 

  12. Deng T, Wang Y, Sun M, Chen B (2013) Stage-matched intervention for adherence to CPAP in patients with obstructive sleep apnea: a randomized controlled trial. Sleep Breath 17(2):791–801. https://doi.org/10.1007/s11325-012-0766-3 Epub 2012 Sep 4

    Article  PubMed  Google Scholar 

  13. Wozniak DR, Lasserson TJ, Smith I (2014) Educational, supportive and behavioural interventions to improve usage of continuous positive airway pressure machines in adults with obstructive sleep apnoea. Cochrane Database Syst Rev 8(1):CD007736. https://doi.org/10.1002/14651858.CD007736.pub2 Update in: Cochrane Database Syst Rev. 2020 Apr 7;4:CD007736.

    Article  Google Scholar 

  14. Rotenberg BW, Murariu D, Pang KP (2016) Trends in CPAP adherence over twenty years of data collection: a flattened curve. J Otolaryngol Head Neck Surg 45(1):43. https://doi.org/10.1186/s40463-016-0156-0 PMID: 27542595; PMCID: PMC4992257

    Article  PubMed  PubMed Central  Google Scholar 

  15. Weaver TE, Maislin G, Dinges DF, Bloxham T, George CF, Greenberg H, Kader G, Mahowald M, Younger J, Pack AI (2007) Relationship between hours of CPAP use and achieving normal levels of sleepiness and daily functioning. Sleep 30(6):711–719. https://doi.org/10.1093/sleep/30.6.711 PMID: 17580592; PMCID: PMC1978355.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Patil SP, Ayappa IA, Caples SM, Kimoff RJ, Patel SR, Harrod CG (2019) Treatment of adult obstructive sleep apnea with positive airway pressure: an American academy of sleep medicine systematic review, meta-analysis, and GRADE assessment. J Clin Sleep Med 15(2):301–334. https://doi.org/10.5664/jcsm.7638 PMID: 30736888; PMCID: PMC6374080.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Ryan CF, Lowe AA, Li D, Fleetham JA (1991) Magnetic resonance imaging of the upper airway in obstructive sleep apnea before and after chronic nasal continuous positive airway pressure therapy. Am Rev Respir Dis 144(4):939–944. https://doi.org/10.1164/ajrccm/144.4.939

    Article  CAS  PubMed  Google Scholar 

  18. Campos-Rodriguez F, Martinez-Garcia MA, Reyes-Nuñez N, Caballero-Martinez I, Almeida-Gonzalez CV, Catalan-Serra P, Peña-Griñan N (2013) Long-term continuous positive airway pressure compliance in females with obstructive sleep apnoea. Eur Respir J 42(5):1255–1262. https://doi.org/10.1183/09031936.00165812 Epub 2013 Feb 8

    Article  PubMed  Google Scholar 

  19. Law M, Naughton M, Ho S, Roebuck T, Dabscheck E (2014) Depression may reduce adherence during CPAP titration trial. J Clin Sleep Med 10(2):163–169. https://doi.org/10.5664/jcsm.3444 PMID: 24532999; PMCID: PMC3899318.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Hwang D, Chang JW, Benjafield AV, Crocker ME, Kelly C, Becker KA, Kim JB, Woodrum RR, Liang J, Derose SF (2018) Effect of telemedicine education and telemonitoring on continuous positive airway pressure adherence. The Tele-OSA Randomized Trial. Am J Respir Crit Care Med 197(1):117–126. https://doi.org/10.1164/rccm.201703-0582OC

    Article  PubMed  Google Scholar 

  21. Massie CA, Hart RW, Peralez K, Richards GN (1999) Effects of humidification on nasal symptoms and compliance in sleep apnea patients using continuous positive airway pressure. Chest 116(2):403–408. https://doi.org/10.1378/chest.116.2.403

    Article  CAS  PubMed  Google Scholar 

  22. Mador MJ, Krauza M, Pervez A, Pierce D, Braun M (2005) Effect of heated humidification on compliance and quality of life in patients with sleep apnea using nasal continuous positive airway pressure. Chest 128(4):2151–2158. https://doi.org/10.1378/chest.128.4.2151

    Article  PubMed  Google Scholar 

  23. Koutsourelakis I, Vagiakis E, Perraki E, Karatza M, Magkou C, Kopaka M, Roussos C, Zakynthinos S (2011 Mar) (2010). Nasal inflammation in sleep apnoea patients using CPAP and effect of heated humidification. Eur Respir J 37(3):587–594. https://doi.org/10.1183/09031936.00036910.Epub1

    Article  CAS  PubMed  Google Scholar 

  24. Rowland S, Aiyappan V, Hennessy C, Catcheside P, Chai-Coezter CL, McEvoy RD, Antic NA (2018) Comparing the efficacy, mask leak, patient adherence, and patient preference of three different CPAP interfaces to treat moderate-severe obstructive sleep apnea. J Clin Sleep Med 14(1):101–108. https://doi.org/10.5664/jcsm.6892 PMID: 29198305; PMCID: PMC5734878.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Andrade RGS, Viana FM, Nascimento JA, Drager LF, Moffa A, Brunoni AR, Genta PR, Lorenzi-Filho G (2017) Nasal vs oronasal CPAP for OSA treatment: a meta-analysis. Chest. 153(3):665–674. https://doi.org/10.1016/j.chest.2017.10.044.Epub19

    Article  PubMed  Google Scholar 

  26. Lebret M, Rotty MC, Argento C, Pepin JL, Tamisier R, Arbib F, Jaffuel D, Molinari N, Borel JC (2019) Comparison of auto- and fixed-continuous positive airway pressure on air leak in patients with obstructive sleep apnea: data from a randomized controlled trial. Can Respir J 2019:6310956. https://doi.org/10.1155/2019/6310956 PMID: 31485282; PMCID: PMC6702837.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Baltzan MA, Dabrusin R, Garcia-Asensi A, Sully JL, Parenteau M, Tansimat G, Kassissia I, Wolkove N (2011) Leak profile inspection during nasal continuous positive airway pressure. Respir Care 56(5):591–595. https://doi.org/10.4187/respcare.00977 Epub 2011 Jan 27

    Article  PubMed  Google Scholar 

  28. Jacobsen AR, Eriksen F, Hansen RW, Erlandsen M, Thorup L, Damgård MB, Kirkegaard MG, Hansen KW (2017) Determinants for adherence to continuous positive airway pressure therapy in obstructive sleep apnea. PLoS One 12(12):e0189614. https://doi.org/10.1371/journal.pone.0189614 PMID: 29253872; PMCID: PMC5734784.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Gagnadoux F, Le Vaillant M, Paris A, Pigeanne T, Chollet S, Masson P, Bizieux-Thaminy A, Humeau MP, Meslier N, IRSR Sleep Cohort Group (2013) Adherence to positive airway pressure in non-sleepy patients with obstructive sleep apnoea. Eur Respir J 42(3):863–866. https://doi.org/10.1183/09031936.00035713

    Article  PubMed  Google Scholar 

  30. Wohlgemuth WK, Chirinos DA, Domingo S, Wallace DM (2015) Attempters, adherers, and non-adherers: latent profile analysis of CPAP use with correlates. Sleep Med 16(3):336–342. https://doi.org/10.1016/j.sleep.2014.08.013 Epub 2014 Sep 17

    Article  PubMed  Google Scholar 

  31. Kohler M, Smith D, Tippett V, Stradling JR (2010) Predictors of long-term compliance with continuous positive airway pressure. Thorax 65(9):829–832. https://doi.org/10.1136/thx.2010.135848

    Article  PubMed  Google Scholar 

  32. McArdle N, Devereux G, Heidarnejad H, Engleman HM, Mackay TW, Douglas NJ (1999) Long-term use of CPAP therapy for sleep apnea/hypopnea syndrome. Am J Respir Crit Care Med 159(4 Pt 1):1108–1114. https://doi.org/10.1164/ajrccm.159.4.9807111

    Article  CAS  PubMed  Google Scholar 

  33. Bros JS, Poulet C, Arnol N, Deschaux C, Gandit M, Charavel M (2018) Acceptance of telemonitoring among patients with obstructive sleep apnea syndrome: how is the perceived interest by and for patients? Telemed J E Health 24(5):351–359. https://doi.org/10.1089/tmj.2017.0134 Epub 2017 Oct 13

    Article  PubMed  Google Scholar 

  34. Turino C, de Batlle J, Woehrle H, Mayoral A, Castro-Grattoni AL, Gómez S, Dalmases M, Sánchez-de-la-Torre M, Barbé F (2017) Management of continuous positive airway pressure treatment compliance using telemonitoring in obstructive sleep apnoea. Eur Respir J 49(2):1601128. https://doi.org/10.1183/13993003.01128-2016

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors would like to acknowledge the contribution of a medical writer, Sandy Field, PhD, for the editing of this manuscript.

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Authors and Affiliations

  1. Department of Pulmonary Medicine, CHU Saint-Pierre, Brussels, Belgium

    Sarah Carlier & Marie Bruyneel

  2. Université Libre de Bruxelles (ULB), Brussels, Belgium

    Sarah Carlier & Marie Bruyneel

  3. KiCarre, Research Department, Lentilly, France

    Anne Violette Bruyneel

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  1. Sarah Carlier
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Contributions

SC and MB collected the data; SC, AVB, and MB performed data analyses and prepared the manuscript and approved the final version of the manuscript.

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Correspondence to Marie Bruyneel.

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Carlier, S., Bruyneel, A.V. & Bruyneel, M. Pressure adjustment is the most useful intervention for improving compliance in telemonitored patients treated with CPAP in the first 6 months of treatment. Sleep Breath 26, 125–132 (2022). https://doi.org/10.1007/s11325-021-02367-3

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