Effect of remote patient monitoring on PAP adherence and patient-reported outcomes in obstructive sleep apnea: a comparative study.
Ricardo De Armas, Edward Mezerhane, Aron Bobrowski et al.
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In 30 seconds
This prospective, open-label, active-comparator randomized trial compared remote patient monitoring (RPM) with standard care (SOC) in PAP-naive adults with obstructive sleep apnea who owned a smartphone. Among 196 participants, Medicare-defined PAP adherence was 80.6% with RPM and 73.5% with SOC, a difference of 7.1 percentage points (p = 0.308). RPM participants had fewer nights with elevated mask leak and reported greater satisfaction with support, coaching, and issue resolution, but these differences were not significant after adjustment for multiple comparisons. The authors describe the findings as primarily descriptive given the limited sample size.
Key findings
- Medicare-defined PAP adherence was 80.6% with RPM versus 73.5% with SOC (difference 7.1% points; p = 0.308).
- At day 90, median nights with elevated mask leak were 11.2 with RPM and 14.5 with SOC; the adjusted p-value was 0.113.
- RPM participants more often reported the highest satisfaction with support, coaching, and issue resolution, but adjusted p-values were all ≥ 0.11.
Why it matters
PAP effectiveness depends on adherence, making approaches that support ongoing use clinically relevant. This trial provides a randomized comparison of app-based monitoring and coaching with standard coaching, while showing that the observed adherence difference was not statistically significant. The leak and satisfaction findings may inform future evaluations, but their lack of significance after adjustment means they should be interpreted cautiously.
What to keep in mind
The pragmatic sample was limited and was designed to estimate between-arm differences rather than test superiority with conventional power. The trial was open-label, and secondary differences did not remain significant after adjustment for multiple comparisons.