Telemonitoring Might Improve CPAP Adherence for Patients With OSA

For people with obstructive sleep apnea syndrome (OSA), telemonitoring improved the mean nightly hour of continuous positive airway pressure (CPAP) therapy compared with standard care, and motivational enhancement therapy (MET) had the most impact on long-term adherence, according to a systematic literature review and meta-analysis found in Applied Nursing Research.

The certainty for telemonitoring via telemedicine was moderate, and the certainty for MET and behavioral/supportive interventions was very low. Only the secondary outcome of quality of life in the mental dimension was showed a positive impact by behavioral/supportive interventions.

This literature review and meta-analysis was conducted because CPAP is known as a treatment of choice for OSA syndrome, but there was inconclusive evidence on improving CPAP adherence. The researchers were trying to analyze the effectiveness of behavioral and psychosocial interventions for CPAP adherence.

Studies included in the literature review focused on patients newly diagnosed with OSA, naive to CPAP treatment and any kind of behavioral/psychosocial intervention provided to individuals or groups, with adherence to CPAP as an outcome. The patients were 18 or older, had all levels of OSA, were prescribed CPAP treatment, or were currently using CPAP.

After studies were gathered, the researchers used PRISMA guidelines and the JBI (Joanna Briggs Institute) approach for systematic review and meta-analysis. The literature review included randomized and non-randomized controlled trials plus a control group in studies published between 1990 and 2019. A total of 18 randomized controlled trials (RCTs) out of 1657 studies were included in the final review from select countries around the world.

In the study, the comparator was usual or standard care or interventions excluding behavioral modification and/or psychological intervention, and/or pharmacological therapy.

The primary outcome measured was CPAP adherence, and secondary outcomes included daytime sleepiness, daytime functioning and self-reported quality of life, and physiological changes like blood pressure.

It was found that telemonitoring raised the mean nightly hour of CPAP use compared with standard care (weighted mean difference [WMD] = .76; 95% CI, 0.31–1.20; P = .001; I² = 0 %, moderate certainty of evidence).

For MET, there was a very low degree of certainty of evidence that it increased adherence (WMD = 1.22; 95 % CI, 0.28–2.16; P = .011, I² = 65%).

Mean nightly CPAP use improvement followed behavioral/supportive interventions in the short term (WMD = 1.49, 95 % CI, 0.16–2.81, P = .029, I² = 30%, very low certainty of evidence) and long term (WMD = 1.67, 95 % CI, 1.55–1.79, P = 0, I² = 0%, very low certainty of evidence).

Behavioral/supportive interventions produced the most improvement for mean hours of CPAP use per night, but certainty of evidence was very low. MET also improved mean hours of CPAP use, but the researchers were less inclined to recommend MET and behavioral/supportive interventions to boost CPAP adherence due to heterogeneity of studies.

They went on to say, “Nevertheless, for interventions in which subgroup analysis was analyzed, telemedicine and MET improved for only short-term follow-up, whereas behavioral/supportive interventions improved two follow-up times for mean hours of CPAP use.”

The only interventions that affected any secondary outcome was the improvement of quality of life for behavioral/supportive interventions, but there were only 2 studies in the analysis, so future research is needed.

These results indicated that feedback from researchers and clinicians can help patients manage side effects and other possible issues in real time. This process of shared decision making that incorporates patient preferences and values can increase CPAP adherence and utilization, and follow-up after initial contact can maintain that improvement. Use of MET might also benefit patient quality of life.

The authors said that almost all the studies in the review were at a serious to very serious risk of bias, and performance bias was found. Despite this, blinding for outcome accessors in the review was about 55.6%.

Limitations included the inaccessibility of the full version of 8 studies, missing data stopped them from conducting meta-analysis for some intervention types, and their search was limited to studies published in English or Thai.

Reference

Chaiard J, Bhatarasakoon P. Effectiveness of behavioral and psychosocial interventions for continuous positive airway pressure adherence among patients with obstructive sleep apnea: a systematic review and meta-analysis. Appl Nurs Res. 2023;69:151654. doi:10.1016/j.apnr.2022.151654