Enabling Sleep Apnea Patient-Centered Care Via an Internet Intervention

Obstructive sleep apnea syndrome (OSA) is a common type of sleep apnea and is caused by obstruction of the airway. Treatment is with a continuous positive airway pressure (CPAP) flow generator, a machine used at night by patients to create positive pressure of air via a facemask or nasal pillow in order to keep the airway open. Adherence to this treatment is typically poor: while CPAP should be used throughout a night of sleep, use is typically on the order of 3 to 5 hours. It has been found that if proper CPAP use is established from the beginning, users are more likely to be adherent with the treatment. In order to improve adherence to CPAP use, this project developed an Internet portal integrated with a telemetry treatment device designed to provide new users of CPAP with access to their clinical data, educational materials, and support. The CPAP machine was able to wirelessly upload data to the portal so that patient-use information could be viewed by both the patient and the provider. Data collected included adherence to CPAP use, the amount of air leaking around the mask or pillow, and the number of apnea episodes per hour.

The main objectives of this project were to:

• Examine the effect of the myCPAP intervention compared to usual care on the patient’s experience of the quality of patient-centered, collaborative care (as measured by the Patient Assessment of Chronic Illness Care and the modified Consumer Assessment of Healthcare Providers and Systems Clinician & Group Survey).
• Examine the effect of the myCPAP Internet intervention compared to usual care on level of CPAP adherence.
• Examine the effect of myCPAP, compared to usual care, on obstructive sleep apnea outcomes (e.g., OSA symptoms and OSA-specific health-related quality of life).

The project was evaluated with a randomized clinical trial comparing the intervention group, called myCPAP, to a usual care group. The key measurement was the amount of time CPAP was used at the pressure prescribed by the clinician. The patients in the myCPAP group had a statistically significant higher rate of nearly an hour of CPAP adherence at 2 months compared with the usual care group. At 4 months the intervention group remained higher than the usual care group, although the difference was not statistically significant. The two groups did not differ on the number of outcomes measured, which included sleepiness, depressive symptoms, vigilance, and OSA-related quality of life. The project team felt that this indicated that an increase of an hour of CPAP use was not enough time to impact these measures.