Rationale– Automated telemedicine interventions could potentially improve adherence to continuous positive airway pressure therapy (CPAP). Objective–Examining the effects of telemedicine-delivered obstructive sleep apnea (OSA) education and CPAP telemonitoring with automated patient feedback messaging on CPAP adherence. Methods–This 4-arm, randomized, factorial-design clinical trial enrolled 1455 patients (51.0% women, age 49.1±12.5 years) referred for suspected OSA. 956 underwent home sleep apnea testing and 556 were prescribed CPAP. Two telemedicine interventions were implemented: (a) web-based OSA education (Tel-Ed); (b) CPAP telemonitoring with automated patient feedback (Tel-TM). Patients were randomized to (1) Usual Care, (2) Tel-Ed added, (3) Tel-TM added, or (4) Tel-Ed and Tel-TM added (Tel-Both). Measurements–Primary endpoint was 90-day CPAP usage. Secondary endpoints included attendance to OSA evaluation, and change in Epworth Sleepiness Scale score. Main Results– CPAP average daily use at 90 days was 3.8±2.5, 4.0±2.4, 4.4±2.2 and 4.8±2.3 hours in Usual Care, Tel-Ed, Tel-TM and Tel-Both groups. Usage was significantly higher in the Tel-TM and Tel-Both groups versus Usual Care (p=0.0002 for both) but not for Tel-Ed (p=0.10). Medicare adherence rates were 53.5%, 61.0%, 65.6% and 73.2% in Usual Care, Tel-Ed, Tel-TM and Tel-Both groups (Tel-Both vs Usual Care, p=0.001; Tel-TM vs Usual Care, p=0.003; Tel-Ed vs Usual Care, p=0.07). Telemedicine education improved clinic attendance compared to no telemedicine education (show rate 68.5% vs 62.7%; p=0.02). Conclusions–The use of CPAP telemonitoring with automated feedback messaging improved 90-day adherence in OSA patients. Telemedicine-based education did not significantly improve CPAP adherence but did increase clinic attendance for OSA evaluation. Clinical trial registration available at www.clinicaltrials.gov, ID NCT02279901.

中文翻译：

---

远程医疗教育和远程监控对CPAP依从性的影响：Tele-OSA随机试验

理由–自动化的远程医疗干预措施可能会改善对持续气道正压通气疗法（CPAP）的依从性。目的–通过自动患者反馈消息，检查远程医疗传递的阻塞性睡眠呼吸暂停（OSA）教育和CPAP远程监护对CPAP依从性的影响。方法–这项4臂，随机，因子设计的临床试验招募了1455例疑似OSA的患者（女性51.0％，年龄49.1±12.5岁）。956人接受了家庭睡眠呼吸暂停测试，其中556人接受了CPAP处方。实施了两种远程医疗干预措施：（a）基于网络的OSA教育（Tel-Ed）；（b）具有自动患者反馈（Tel-TM）的CPAP远程监视。患者被随机分配至（1）日常护理，（2）添加了Tel-Ed，（3）添加了Tel-TM或（4）添加了Tel-Ed和Tel-TM（Tel-Both）。测量–主要终点为90天CPAP使用量。次要终点包括参加OSA评估以及Epworth Sleepiness Scale评分的变化。主要结果–在日常护理，Tel-Ed，Tel-TM和Tel-Both组中，CPAP在90天的平均每日使用时间分别为3.8±2.5、4.0±2.4、4.4±2.2和4.8±2.3小时。与常规护理相比，Tel-TM和Tel-Both组的使用率显着更高（两者均为p = 0.0002），而Tel-Ed的使用率则没有（p = 0.10）。在“日常护理”，“ Tel-Ed”，“ Tel-TM”和“ Tel-Both”组中，Medicare依从率分别为53.5％，61.0％，65.6％和73.2％（Tel-Both vs.Usual Care，p = 0.001； Tel-TM vs.Usual Care， p = 0.003； Tel-Ed vs.Usual Care，p = 0.07）。与没有远程医疗教育相比，远程医疗教育提高了门诊率（显示率68.5％vs 62.7％； p = 0.02）。结论–将CPAP远程监控与自动反馈消息配合使用可改善OSA患者的90天依从性。基于远程医学的教育并未显着改善CPAP的依从性，但确实增加了OSA评估的门诊率。可通过www.clinicaltrials.gov获得IDC NCT02279901的临床试验注册信息。