2020年3月
A Randomized Controlled Trial of Telemedicine for Long-Term Sleep Apnea Continuous Positive Airway Pressure Management
ANNALS OF THE AMERICAN THORACIC SOCIETY
- 巻
- 17
- 号
- 3
- 開始ページ
- 329
- 終了ページ
- 337
- 記述言語
- 英語
- 掲載種別
- 研究論文(学術雑誌)
- DOI
- 10.1513/AnnalsATS.201907-494OC
- 出版者・発行元
- AMER THORACIC SOC
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.
- リンク情報
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- DOI
- https://doi.org/10.1513/AnnalsATS.201907-494OC
- PubMed
- https://www.ncbi.nlm.nih.gov/pubmed/31689141
- Web of Science
- https://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcAuth=JSTA_CEL&SrcApp=J_Gate_JST&DestLinkType=FullRecord&KeyUT=WOS:000518194300015&DestApp=WOS_CPL
- Scopus
- https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85079492786&origin=inward
- Scopus Citedby
- https://www.scopus.com/inward/citedby.uri?partnerID=HzOxMe3b&scp=85079492786&origin=inward
- ID情報
-
- DOI : 10.1513/AnnalsATS.201907-494OC
- ISSN : 1546-3222
- eISSN : 2325-6621
- PubMed ID : 31689141
- SCOPUS ID : 85079492786
- Web of Science ID : WOS:000518194300015