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RATIONALE
Continuous positive airway pressure (CPAP) is the standard treatment for the obstructive sleep apnea syndrome (OSAS), but long-term adherence remains a challenge. In a pilot study, we observed that telemedicine combined with telemetrically-triggered interventions was associated with improved CPAP adherence in the first month of treatment.

OBJECTIVES
In the current randomized, controlled phase III trial, we aimed at collecting pivotal data for the use of telemedicine in CPAP treatment of patients with OSAS.

METHODS
Symptomatic OSAS patients were randomized to a telemedicine or control arm and initiated CPAP treatment. Phone calls were triggered in the telemedicine group during the first month of treatment either upon poor usage or excessive mask leakage. Patients were followed for 6 months. Measures of CPAP usage at 6 months were the main study endpoints.

RESULTS
Among 240 patients enrolled, 71 (30%) discontinued CPAP treatment over the course of the study. The primary outcome measure, the proportion of nights with CPAP usage ≥1 h, was not statistically different in the telemedicine (92.0%) versus the control group (88.2%) (p=0.565). The daily hours of CPAP usage at 6 months also did not differ significantly between the telemedicine (5.6 h) and the control group (4.8 h) (p=0.663). However, in a post-hoc analysis, telemedicine led to increased device usage in a subgroup of patients with a mild form of disease (5.6 h versus 3.4 h, p=0.026). The telemedicine-based intervention had a positive impact on sleep-related quality of life, as measured with Quebec Sleep Questionnaire (5.55 versus 5.49 at 1 month, p=0.020; 5.61 vs 5.46 at 6 months, p=0.013).

CONCLUSIONS
A telemetrically-triggered intervention in the first month of treatment did not improve CPAP usage in the study population overall, yet had positive effects in patients with a mild form of OSAS and led to an improvement in sleep-related quality of life. Clinical trial registered with ClinicalTrial.gov (NCT01715194).