Intensive Communication by Health Professionals Added to Web-Based Telemedicine Does Not Improve PAP Adherence in OSA Patients

Background: Although web-based telemedicine (WBT) in association with intensive communication by health professionals has been demonstrated to improve PAP adherence in OSA patients, there has been no study aimed at differentiating the impact of communication by health professionals on PAP adherence from that of WBT alone. The purpose of this study is to estimate the significance of communication by a health professional on PAP-associated variables under conditions in which OSA patients were treated with PAP equipped with a modem allowing intensive WBT monitoring. Design: A single-center, randomized trial. Patients: Newly-diagnosed adult patients (more than 20 years old) with moderate-to-severe OSA (n=70), who were fresh for PAP use. Interventions: The patients were randomized into P1group (n=34) and P2group (n=36). The P1group measurements were focused on evaluating the supplementary effect of communication by a health professional as an adjunct to WBT monitoring on PAP-related variables. The P2 group was designed to measure the withdrawal effect of a health professional from WBT monitoring. Observation periods: 6 months. Primary outcome: PAP adherence based on an average of the total time of PAP use and an average percentage of days in which PAP is used over four hours at night. Secondary outcomes: PAP-related physiological variables including air leakage and apnea-hypopnea index (AHI). Results: WBT alone substantially improved PAP adherence. Neither the addition nor the withdrawal of communication by a health professional modified PAP adherence. Irrespective of the study protocols, air leakage was reduced in a time-dependent manner. Conclusion: The crucial factor for improving PAP adherence is the introduction of web-based telemedicine, whereas the addition of a health professional's contribution might have little effect on PAP adherence so far as the web-based telemedicine monitoring is already or simultaneously applied.