55 The use of telemedicine in the management of continuous positive airway pressure for the treatment of obstructive sleep apnoea, a randomised controlled trial

Introduction: Obstructive sleep apnoea (OSA) is a condition whereby the airway partially or totally obstructs during sleep. The gold-standard treatment for moderate to severe OSA is continuous positive airway pressure (CPAP). However compliance with treatment can be troublesome with 20-30% of patients stopping treatment. A recent meta-analytic review (Aardoom et al 2000) of telemedicine in CPAP treatment has concluded that the effectiveness of telemedicine on adherence remains undecided.

Methods: A non-blinded, single centre, randomised controlled trial was carried out with patients randomised to 1 of 3 arms (arm 1 standard care and face-to-face appointments; arm 2 modem and virtual follow up clinic; arm 3 modem, Dreammapper™ and virtual follow up appointment). Consecutive moderate-severe OSA patients requiring CPAP were recruited to the study to a sample size of 90. Data was collected at first appointment, at 1st follow up from commencing CPAP (1-2 weeks) and at 6 months from commencing CPAP. Data collection included patient’s demographics (table 1), CPAP compliance (average hours of usage in 24 hours), mask leak, apnoea/hypopnoea index (AHI) and Epworth sleepiness scores (ESS). Qualitative data is currently being collected via interviews to explore the patient experience in each arm of the study.

Discussion: Preliminary analysis (table 2) indicates that arm 3 demonstrated significant better compliance of 36 minutes at first follow up compared to arm 1, with compliance at 6 months between both these arms levelling out with no significant difference at 6 months. The patient group in arm 2 demonstrated a significantly reduced in compliance compared to the other two groups at both week 1-2 and 6 months. Preliminary results suggest that the type of telemedicine intervention could impact the early compliance experienced by patients.