E- HEALTH TELEMONITORING PROJECT IN PATIENTS WITH SLEEP APNEA SYNDROME LOW CPAP TREATMENT WITH LOW FULFILLMENT

CPAP (Continuous Positive Pressure) is the treatment of choice in AOS. Discontinuation or insufficient use may lead to a relapse of symptoms that brings back cardiovascular risks to unacceptable levels. Worldwide current estimations place the patients’ non-adherence to CPAP treatment between 30 and 60% rate one year after the initiation of therapy. In 2021 patient’s evaluation from the Sleep Cohort of Vitoria (4274 patients treated with CPAP) showed a 15% rate of non-adherence. Although there is no data to accurately define the amount of sleep needed for each person, CPAP treatment has shown to be effective for those who stay sleep longer than 3-4 hours/night for at least 70% of nights.
There are multiple approaches to improve CPAP patient adherence; however most of them have been expensive or difficult to reproduce. Currently state-of-the-art information technologies such as telemonitoring are now available. They promote the exchange of information sending crucial treatment data to a platform (leaks, airflow, pressure, IAH and leakage) to enhance management of condition and resources on a daily basis.

OBJECTIVE: To evaluate the effectiveness of the use of telemonitoring equipment on improving CPAP patients’ adherence.

METHODOLOGY: Prospective analysis of 174 patients of the CPAP Botoom-UP project (June-December2016) who presented a adherence measured by objective hour counter of 1 to 3 hours, monitored in the Sleep Unit of the OSI- Araba HU Hospital (Basque Country, Spain) for more than 6 months.
After the initial clinical appointment at the doctor’s office (Time T0), and acting on the possible causes that represent a cause of low adherence, the telemonitoring devices (modemT4P SRETT via GPRS or ResMedAirSense10AutoSetAPAP or Philips Respironics DreamStation) were installed for four weeks (T1). Throughout this time the follow parameters were daily recorded online: leakage, pressure, apnea-hyponea index (AHI) and time compliance.
Adherence results were analysed at 4 weeks of treatment (T1), deciding:
1. -Excellent
2. -Withdraw CPAP
3. -Search for alternatives to treatment.

Adherence was reassessed at 3 months (T2) and 6 months (T3).

RESULTS: At 4 weeks (T1) the CPAP patients’ usage improved by the use of telemonitoring equipment from 2. 0±0. 7 to 5. 8±1. 6h, while patients’ adherence to treatment rates went up from 0% to 92. 2% (p<0. 001) (n= 161). No significant differences were found between the equipment used for monitoring (p-0.723,; modemT4P at 91. 3% , ResMed AirSense10 at 94. 6%). Data from 131 patients were collected and analysed at 3 months (T2): 87. 8% of them (n= 115) maintain adherence to treatment with good hourly usage of equipment (5. 3±1. 7h, p<0. 001 ). Data at 6 months reflected that 81% of patients who have completed the study use CPAP 5. 0±2. 1h (p<0. 001).