A Randomized Controlled Trial of Telemedicine for Long-Term Sleep Apnea Continuous Positive Airway Pressure Management

被引：38

作者：

Murase, Kimihiko ^{[1
]}

Tanizawa, Kiminobu ^{[2
]}

Minami, Takuma ^{[2
]}

Matsumoto, Takeshi ^{[2
,5
]}

Tachikawa, Ryo ^{[2
,6
]}

Takahashi, Naomi ^{[1
]}

Tsuda, Toru ^{[7
]}

Toyama, Yoshiro ^{[8
]}

Ohi, Motoharu ^{[8
]}

Akahoshi, Toshiki ^{[9
]}

Tomita, Yasuhiro ^{[10
]}

Narui, Koji ^{[10
]}

Nakamura, Hiroshi ^{[11
]}

Ohdaira, Tetsuro ^{[12
]}

Yoshimine, Hiroyuki ^{[13
]}

Tsuboi, Tomomasa ^{[14
]}

Yamashiro, Yoshihiro ^{[15
]}

Ando, Shinichi ^{[16
]}

Kasai, Takatoshi ^{[17
]}

Kita, Hideo ^{[18
]}

Tatsumi, Koichiro ^{[19
]}

Burioka, Naoto ^{[20
]}

Tomii, Keisuke ^{[6
]}

Kondoh, Yasuhiro ^{[21
]}

Takeyama, Hirofumi ^{[1
]}

Handa, Tomohiro ^{[3
]}

Hamada, Satoshi ^{[3
]}

Oga, Toru ^{[2
]}

Nakayama, Takeo ^{[22
]}

Sakamaki, Tetsuo ^{[23
]}

Morita, Satoshi ^{[4
]}

Kuroda, Tomohiro ^{[24
]}

Hirai, Toyohiro ^{[2
]}

Chin, Kazuo ^{[1
]}

机构：

[1] Kyoto Univ, Grad Sch Med, Dept Resp Care & Sleep Control Med, Kyoto, Japan

[2] Kyoto Univ, Grad Sch Med, Dept Resp Med, Kyoto, Japan

[3] Kyoto Univ, Grad Sch Med, Dept Adv Med Resp Failure, Kyoto, Japan

[4] Kyoto Univ, Grad Sch Med, Dept Biomed Stat & Bioinformat, Kyoto, Japan

[5] Saiseikai Noe Hosp, Dept Resp Med, Osaka, Japan

[6] Kobe City Med Ctr Gen Hosp, Dept Resp Med, Kobe, Hyogo, Japan

[7] Kirigaoka Tsuda Hosp, Sleep Ctr, Kitakyushu, Japan

[8] Osaka Kaisei Hosp, Sleep Med Ctr, Osaka, Japan

[9] Shinjuku Sleep & Resp Clin, Tokyo, Japan

[10] Toranomon Gen Hosp, Sleep Ctr, Tokyo, Japan

[11] Nakamura Clin, Urazoe, Japan

[12] Nishi Niigata Chuo Natl Hosp, Dept Resp Med, Niigata, Japan

[13] Inoue Hosp, Nagasaki, Japan

[14] Natl Hosp Org, Dept Resp Med, Minami Kyoto Hosp, Joyo, Japan

[15] Ureshinogaoka Samaritan Hosp, Ureshino, Okinawa, Japan

[16] Kyushu Univ Hosp, Sleep Apnea Ctr, Fukuoka, Japan

[17] Juntendo Univ, Cardiovasc Resp Sleep Med, Grad Sch Med, Tokyo, Japan

[18] Takatsuki Red Cross Hosp, Dept Resp Med, Takatsuki, Osaka, Japan

[19] Chiba Univ, Grad Sch Med, Dept Respirol, Chiba, Japan

[20] Tottori Univ, Sch Hlth Sci, Dept Pathobiol Sci & Technol, Fac Med, Tottori, Japan

[21] Tosei Gen Hosp, Dept Resp Med & Allergy, Seto, Japan

[22] Kyoto Univ, Dept Hlth Informat, Sch Publ Hlth, Kyoto, Japan

[23] Gunma Univ, Syst Integrat Ctr, Gunma, Japan

[24] Kyoto Univ Hosp, Div Med Informat Technol & Adm Planning, Kyoto, Japan

来源：

ANNALS OF THE AMERICAN THORACIC SOCIETY | 2020年 / 17卷 / 03期

关键词：

sleep apnea; continuous positive airway pressure; telemedicine; adherence; MOTIVATIONAL ENHANCEMENT; CARDIOVASCULAR OUTCOMES; JAPANESE VERSION; CPAP ADHERENCE; RISK; THERAPY; DISEASE;

D O I：

10.1513/AnnalsATS.201907-494OC

中图分类号：

R56 [呼吸系及胸部疾病];

学科分类号：

摘要：

Rationale: The effects of telemedicine on adherence in patients with obstructive sleep apnea with long-term continuous positive airway pressure (CPAP) use have never been investigated. Objectives: To examine effects of a telemedicine intervention on adherence in long-term CPAP users. Methods: In a prospective, randomized, multicenter noninferiority trial conducted in 17 sleep centers across Japan, patients who had used CPAP for >3 months and were receiving face-to-face follow-up by physicians every 1 or 2 months were randomized by a coordinating center in a blind manner to the following three groups: 1) follow-up every 3 months accompanied by a monthly telemedicine intervention (telemedicine group: TM-group), 2) follow-up every 3 months (3-month group: 3M-group), or 3) monthly follow-up (1-month group: 1M-group). Each group was followed up for 6 months. The change in percentage of days with >= 4 h/night of CPAP use from baseline to the end of the study period was evaluated. A decline of >= 5% from baseline was considered deterioration of adherence. Noninferiority of TM- and 3M-groups compared with the 1M-group according to the number of patients with deterioration of adherence was evaluated with the Farrington and Manning test (noninferiority margin 15%). Results: A total of 483 patients were analyzed (median duration of CPAP use, 29 [interquartile range, 12-71] mo), and deterioration of adherence was found in 41 of 161 (25.5%), 55 of 166 (33.1%), and 35 of 156 (22.4%) patients in the TM-, 3M-, and 1M-groups, respectively. The noninferiority of the TM-group compared with the 1M-group was verified (difference in percentage of patients with adherence deterioration, 3.0%; 95% confidence interval [CI], -4.8% to 10.9%; P < 0.01). Conversely, the 3M-group did not show noninferiority to the 1M-group (percentage difference, 10.7%; 95% CI, 2.6% to 18.8%; P = 0.19). In the stratified analysis, adherence in TM- and 1M-group patients with poor adherence at baseline improved (TM: 45.8% +/- 18.2% to 57.3% +/- 24.4%; P < 0.01; 1M: 43.1% +/- 18.5% to 53.6% 24.3%; P < 0.01), whereas that of the 3M-group did not (39.3% +/- 20.8% to 39.8% +/- 24.8%; P =0.84). Conclusions: Intensive telemedicine support could help to optimize CPAP adherence even after long-term CPAP use.

引用

页码：329 / 337

页数：9

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