A Randomized Controlled Trial of Telemedicine for Long-Term Sleep Apnea Continuous Positive Airway Pressure Management.
| Autor: | Kimihiko Murase, Kiminobu Tanizawa, Takuma Minami, Takeshi Matsumoto, Ryo Tachikawa, Naomi Takahashi, Toru Tsuda, Yoshiro Toyama, Motoharu Ohi, Toshiki Akahoshi, Yasuhiro Tomita, Koji Narui, Hiroshi Nakamura, Tetsuro Ohdaira, Hiroyuki Yoshimine, Tomomasa Tsuboi, Yoshihiro Yamashiro, Shinichi Ando, Takatoshi Kasai, Hideo Kita |
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| Předmět: |
TELEMEDICINE
RANDOMIZED controlled trials APNEA treatment MEDICAL care PHYSICIANS SLEEP apnea syndrome treatment RESEARCH CONTINUOUS positive airway pressure RESEARCH methodology MEDICAL cooperation EVALUATION research TREATMENT effectiveness COMPARATIVE studies PATIENT compliance PATIENT education STATISTICAL sampling LONGITUDINAL method |
| Zdroj: | Annals of the American Thoracic Society; Mar2020, Vol. 17 Issue 3, p329-E27, 36p |
| Abstrakt: | Rationale: The effects of telemedicine on adherence in patients with obstructive sleep apnea with long-term continuous positive airway pressure (CPAP) use have never been investigated.Objectives: To examine effects of a telemedicine intervention on adherence in long-term CPAP users.Methods: In a prospective, randomized, multicenter noninferiority trial conducted in 17 sleep centers across Japan, patients who had used CPAP for >3 months and were receiving face-to-face follow-up by physicians every 1 or 2 months were randomized by a coordinating center in a blind manner to the following three groups: 1) follow-up every 3 months accompanied by a monthly telemedicine intervention (telemedicine group: TM-group), 2) follow-up every 3 months (3-month group: 3M-group), or 3) monthly follow-up (1-month group: 1M-group). Each group was followed up for 6 months. The change in percentage of days with ≥4 h/night of CPAP use from baseline to the end of the study period was evaluated. A decline of ≥5% from baseline was considered deterioration of adherence. Noninferiority of TM- and 3M-groups compared with the 1M-group according to the number of patients with deterioration of adherence was evaluated with the Farrington and Manning test (noninferiority margin 15%).Results: A total of 483 patients were analyzed (median duration of CPAP use, 29 [interquartile range, 12-71] mo), and deterioration of adherence was found in 41 of 161 (25.5%), 55 of 166 (33.1%), and 35 of 156 (22.4%) patients in the TM-, 3M-, and 1M-groups, respectively. The noninferiority of the TM-group compared with the 1M-group was verified (difference in percentage of patients with adherence deterioration, 3.0%; 95% confidence interval [CI], -4.8% to 10.9%; P < 0.01). Conversely, the 3M-group did not show noninferiority to the 1M-group (percentage difference, 10.7%; 95% CI, 2.6% to 18.8%; P = 0.19). In the stratified analysis, adherence in TM- and 1M-group patients with poor adherence at baseline improved (TM: 45.8% ± 18.2% to 57.3% ± 24.4%; P < 0.01; 1M: 43.1% ± 18.5% to 53.6% ± 24.3%; P < 0.01), whereas that of the 3M-group did not (39.3% ± 20.8% to 39.8% ± 24.8%; P = 0.84).Conclusions: Intensive telemedicine support could help to optimize CPAP adherence even after long-term CPAP use.Clinical trial registered with www.umin.ac.jp/ctr/index.htm (trial number: UMIN000023118). [ABSTRACT FROM AUTHOR] |
| Databáze: | Complementary Index |
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