Patient Engagement Using New Technology to Improve Adherence to Positive Airway Pressure Therapy
Open accessAbstract
Background Sleep apnea has major neurocognitive and cardiovascular and metabolic risks. Treatment of sleep apnea is suboptimal because of variable adherence to existing therapies.Methods This trial compared positive airway pressure adherence among patients who were provided active patient engagement (APE) technology vs those who received usual care monitoring (UCM). The primary outcome was expressed by using the US Medicare definition of adherence. Adherence data from two cloud-based databases (AirView and myAir) were analyzed for patients with sleep apnea. Data were included if a patient's activation date in the APE tool was within 7 days of the therapy start date in the UCM database during a defined time window. Data were propensity matched in a 1:2 ratio (APE:UCM) based on baseline patient characteristics.Results A total of 128,037 patients were analyzed. Baseline characteristics were typical of a sleep clinic cohort. APE was associated with more patients achieving adherence criteria (87.3%) compared with UCM patients (70.4%; P < .0001 for the difference). Average therapy usage was 5.9 h per night in the APE group vs 4.9 h per night in the matched UCM patients (P < .0001). Patients with sleep apnea "struggling" with therapy adherence had a 17.6% absolute improvement in adherence using APE compared with UCM.Conclusions Robust therapy adherence rates can be achieved by adding modern technology to usual care. Adopting advances in technology in care management may allow clinicians to more effectively and efficiently treat patients who have sleep apnea. Rigorous randomized controlled trials may be required before making strong clinical recommendations.
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A large database analysis showed 87% adherence at 90 days in patients who enrolled in internet-based active patient engagement software.
“A large database analysis showed an outstanding 87% adherence at 90 days in patients who enrolled in internet-based active patient engagement software.1197”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [1197]
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Cites
Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study
Heinzer, R., Vat, S., Marques-Vidal, P., Marti-Soler, H., Andries, D., Tobback, N., Mooser, V, Preisig, M., Malhotra, A., Waeber, G., et al. (2015) · The Lancet Respiratory Medicine · doi:10.1016/s2213-2600(15)00043-0 · Cited by 2,481 · see citing works
Self-citationCPAP for Prevention of Cardiovascular Events in Obstructive Sleep Apnea
McEvoy, R. D., Antic, N. A., Heeley, E., Luo, Y., Ou, Q., Zhang, X., Mediano, O., Chen, R., Drager, L. F., Liu, Z., et al. (2016) · New England Journal of Medicine · doi:10.1056/nejmoa1606599 · Cited by 2,101 · see citing works
Adult obstructive sleep apnoea
Jordan, A. S., McSharry, D. G., & Malhotra, A. (2014) · The Lancet · doi:10.1016/s0140-6736(13)60734-5 · Cited by 1,735 · see citing works
Self-citationAdherence to Continuous Positive Airway Pressure Therapy: The Challenge to Effective Treatment
Weaver, T. E., & Grunstein, R. R. (2008) · Proceedings of the American Thoracic Society · doi:10.1513/pats.200708-119mg · Cited by 1,680 · see citing works
Peker, Y., Glantz, H., Eulenburg, C., Wegscheider, K., Herlitz, J., & Thunström, E. (2016) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201601-0088oc · Cited by 756 · see citing works
HOY, C. J., VENNELLE, M., KINGSHOTT, R. N., ENGLEMAN, H. M., & DOUGLAS, N. J. (1999) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/ajrccm.159.4.9808008 · Cited by 379 · see citing works
Clinical Predictors of the Respiratory Arousal Threshold in Patients with Obstructive Sleep Apnea
Edwards, B. A., Eckert, D. J., McSharry, D. G., Sands, S. A., Desai, A., Kehlmann, G., Bakker, J. P., Genta, P. R., Owens, R. L., White, D. P., et al. (2014) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201404-0718oc · Cited by 312 · see citing works
Self-citationSchwab, R. J., Badr, S. M., Epstein, L. J., Gay, P. C., Gozal, D., Kohler, M., Levy, P. A., Malhotra, A., Phillips, B. A., Rosen, I. M., et al. (2013) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201307-1282st · Cited by 307 · see citing works
Self-citationMukherjee, S., Patel, S. R., Kales, S. N., Ayas, N., Strohl, K. P., Gozal, D., & Malhotra, A. (2015) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201504-0767st · Cited by 300 · see citing works
Self-citationAyas, N., Patel, S. R., Malhotra, A., Schulzer, M., Malhotra, M., Jung, D., Fleetham, J. A., & White, D. P. (2004) · SLEEP · doi:10.1093/sleep/27.2.249 · Cited by 251 · see citing works
Self-citationWeaver, T. E., Mancini, C., Maislin, G., Cater, J., Staley, B., Landis, J. R., Ferguson, K. A., George, C. F. P., Schulman, D. A., Greenberg, H., et al. (2012) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201202-0200oc · Cited by 227 · see citing works
Fox, N., Hirsch-Allen, A., Goodfellow, E., Wenner, J., Fleetham, J., Ryan, C. F., Kwiatkowska, M., & Ayas, N. T. (2012) · Sleep · doi:10.5665/sleep.1728 · Cited by 197 · see citing works
Kim, J. Y., Wineinger, N. E., & Steinhubl, S. R. (2016) · Journal of Medical Internet Research · doi:10.2196/jmir.5429 · Cited by 180 · see citing works
Interventions to improve use of continuous positive airway pressure for obstructive sleep apnoea
Smith, I., Lasserson, T. J., & Haniffa, M. A. (2004) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd003531.pub2 · Cited by 152 · see citing works
Treatment Adherence and Outcomes in Flexible vs Standard Continuous Positive Airway Pressure Therapy
Aloia, M. S., Stanchina, M. L., Arnedt, J. T., Malhotra, A., & Millman, R. P. (2005) · CHEST Journal · doi:10.1378/chest.127.6.2085 · Cited by 150 · see citing works
Self-citationOn the cutting edge of obstructive sleep apnoea: where next?
Malhotra, A., Orr, J. E., & Owens, R. L. (2015) · The Lancet Respiratory Medicine · doi:10.1016/s2213-2600(15)00051-x · Cited by 98 · see citing works
Self-citationAir Leak is Associated with Poor Adherence to Autopap Therapy
Valentin, A., Subramanian, S., Quan, S. F., Berry, R. B., & Parthasarathy, S. (2011) · SLEEP · doi:10.5665/sleep.1054 · Cited by 96 · see citing works
Adherence to Sleep Apnea Therapy and Use of Lipid-Lowering Drugs
Platt, A. B., Kuna, S. T., Field, S., Chen, Z., Gupta, R., Roche, D. F., Christie, J. D., & Asch, D. A. (2009) · CHEST Journal · doi:10.1378/chest.09-0842 · Cited by 92 · see citing works
Munafo, D. A., Hevener, W., Crocker, M. E., Willes, L., Sridasome, S., & Muhsin, M. (2016) · Sleep And Breathing · doi:10.1007/s11325-015-1298-4 · Cited by 89 · see citing works
Self-citationBakker, J. P., Edwards, B. A., Gautam, S., Montesi, S. B., Durán‐Cantolla, J., Barandiarán, F. A., Barbé, F., Sánchez‐de‐la‐Torre, M., & Malhotra, A. (2014) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.3604 · Cited by 75 · see citing works
Self-citationTreatment of Obstructive Sleep Apnea. Prospects for Personalized Combined Modality Therapy
Deacon, N. L., Jen, R., Li, Y., & Malhotra, A. (2015) · Annals of the American Thoracic Society · doi:10.1513/annalsats.201508-537fr · Cited by 65 · see citing works
Self-citationStanchina, M. L., Robinson, K., Corrao, W. M., Donat, W. E., Sands, S. A., & Malhotra, A. (2015) · Annals of the American Thoracic Society · doi:10.1513/annalsats.201410-469bc · Cited by 61 · see citing works
Self-citationUnsupervised detection and analysis of changes in everyday physical activity data
Sprint, G., Cook, D. J., & Schmitter‐Edgecombe, M. (2016) · Journal of Biomedical Informatics · doi:10.1016/j.jbi.2016.07.020 · Cited by 54 · see citing works
Putcha, N., Crainiceanu, C., Norato, G., Samet, J. M., Quan, S. F., Gottlieb, D. J., Redline, S. S., & Punjabi, N. M. (2016) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201511-2178oc · Cited by 48 · see citing works
Treatment compliance in patients lost to follow‐up after polysomnography
Lin, H., Zuliani, G. F., Amjad, E. H., Prasad, A. S., Badr, M. S., Pan, C. G., & Rowley, J. A. (2007) · Otolaryngology · doi:10.1016/j.otohns.2006.08.007 · Cited by 46 · see citing works
Air Leak during CPAP Titration as a Risk Factor for Central Apnea
Montesi, S. B., Bakker, J. P., MacDonald, M., Hueser, L. E., Pittman, S. D., White, D. P., & Malhotra, A. (2013) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.3166 · Cited by 42 · see citing works
Self-citationGulati, A., Ali, M., Davies, M., Quinnell, T. G., & Smith, I. (2017) · BMC Pulmonary Medicine · doi:10.1186/s12890-017-0393-7 · Cited by 38 · see citing works
What Is the Future of Sleep Medicine in the United States?
Phillips, B. A., Gozal, D., & Malhotra, A. (2015) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201508-1544ed · Cited by 36 · see citing works
Self-citationAssessment of the impact on compliance of a new CPAP system in obstructive sleep apnea
Wimms, A. J., Richards, G. N., & Benjafield, A. (2012) · Sleep And Breathing · doi:10.1007/s11325-012-0651-0 · Cited by 18 · see citing works
Self-citation
Flagged first, then by citations
Research works printed but not linked: 2
- [8]8. Hoy CJ, Venelle M, Douglas NJ. Can CPAP use be improved? Am J Respir Crit Care Med. 1997;155:304A.
- [15]15. Kline L, Carlson P. Humidification improves NCPAP acceptance and use. Am J Respir Crit Care Med. 1999;159: A427.
Cited by
Sorted by citations
Benjafield, A. V., Ayas, N. T., Eastwood, P. R., Heinzer, R., Ip, M. S. M., Morrell, M. J., Nunez, C. M., Patel, S. R., Penzel, T., Pépin, J.-L., et al. (2019) · The Lancet Respiratory Medicine · doi:10.1016/s2213-2600(19)30198-5 · Cited by 4,326 · see citing works
Self-citationInternational Consensus Statement on Obstructive Sleep Apnea
Chang, J. L., Goldberg, A. N., Alt, J. A., Mohammed, A., Ashbrook, L., Auckley, D., Ayappa, I., Bakhtiar, H., Barrera, J. E., Bartley, B. L., et al. (2023) · International Forum of Allergy & Rhinology · doi:10.1002/alr.23079 · Cited by 350 · see citing works
Self-citationPredictors of Continuous Positive Airway Pressure Adherence in Patients with Obstructive Sleep Apnea
Mehrtash, M., Bakker, J. P., & Ayas, N. (2019) · Lung · doi:10.1007/s00408-018-00193-1 · Cited by 231 · see citing works
O’Mahony, A. M., Garvey, J. F., & McNicholas, W. T. (2020) · Journal of Thoracic Disease · doi:10.21037/jtd-sleep-2020-003 · Cited by 45 · see citing works
- Authors
- Malhotra, A., Crocker, M. E., Willes, L., Kelly, C., Lynch, S., & Benjafield, A. V.
- Affiliations
- University of California San Diego (US)
- ResMed (United States) (US)
- Corresponding author
- Malhotra, Atul
- Venue
- Chest
- Publisher
- Elsevier BV
- Published
- 2018-04
- Volume
- 153
- Issue
- 4
- Pages
- 843-850
- ISSN
- 0012-3692 (ISSN-L)
- PMC
- PMC5989636
- OpenAlex
- W2768364592
- Semantic Scholar
- c81ecb3b65cf3dde70e963282c04e893ff01ca3b
- Cited by
- 138
- References
- 29
- Citations by year
- 2026: 8 · 2025: 11 · 2024: 19 · 2023: 18 · 2022: 21 · 2021: 17 · 2020: 19 · 2019: 18 · 2018: 6
- FWCI
- 8.70
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- CHEST Journal (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- American Thoracic Society (R21 HL121794, RO1 HL 119201, and RO1 HL081823)
- ResMed
- National Institutes of Health (and K24, RO1 HL- 081823)
- University of California, San Diego
- National Heart, Lung, and Blood Institute (R01HL081823, T32HL134632, R21HL121794, R01HL085188, K24HL132105, R01HL119201)
- Topics
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Keywords
- sleep apnea, positive airway pressure, CPAP adherence, patient engagement, care management
- MeSH terms
- Humans, Middle Aged, Patient Compliance, Patient Participation, Retrospective Studies, Treatment Outcome, Sleep Apnea, Obstructive, Biomedical Technology, Continuous Positive Airway Pressure
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