Telemonitoring not superior to CPAP for blood pressure improvement
In patients with obstructive sleep apnea and high cardiovascular risk, remote telemonitoring and continuous positive airway pressure yielded similar improvement in home blood pressure after 6 months, new data indicate.
The telemonitoring strategy, however, was associated with improved adherence and patient-centered outcomes.
“Beyond CPAP usage and signaling of device problems, remote telemonitoring allowing scrutiny of individual patient’s risks by using connected devices measuring physical activity and [blood pressure] appears an attractive option. In this study, we considered how CPAP telemonitoring might be extended to encompass the patient’s cardiometabolic health providing personalized care and multidisease management to high-cardiovascular-risk patients with [obstructive sleep apnea],” researchers wrote in Chest.
For the study, 306 patients were randomly assigned to usual CPAP care or a multimodal remote telemonitoring intervention that used electronic equipment to collect information about blood pressure, symptoms, CPAP side effects and physical activity.
After 6 months, there was no significant difference in systolic home blood pressure — the primary outcome — between patients in the usual care arm and those in the multimodal telemonitoring arm. In the intention-to-treat analysis, morning systolic and diastolic home blood pressure and evening diastolic home blood pressure were lower after 6 months in both treatment groups.
The researchers also found no significant difference between the treatment groups for biological parameters. The multimodal telemonitoring group experienced significant reductions in total cholesterol and triglyceride levels and improvement in HDL cholesterol after 6 months of treatment, and LDL cholesterol significantly decreased in the usual CPAP group only. BMI did not change after treatment in either group.
Physical activity, defined as mean number of steps per day, did not improve in either treatment group after 6 months.
The researchers used the Short Form-12, the Pichot questionnaires and the Epworth Sleepiness Scale (ESS) to assess quality of life, health status, fatigue and sleepiness. Both treatment groups experienced improvements in the ESS and the Pichot fatigue scale; however, the range of improvement was greater in the multimodal telemonitoring group. Similarly, the multimodal telemonitoring group had greater improvement on the physical component of Short Form-12. CPAP adherence was also significantly better with multimodal telemonitoring vs. usual care.
“In patients with [obstructive sleep apnea] and high cardiovascular risk, multimodal telemonitoring was not superior to usual CPAP care for improving [high blood pressure], but did improve CPAP adherence and patient-centered outcomes. Further studies should explore how multimodal telemonitoring can be associated with a personalized physical activity program and coaching to improve patient engagement and empowerment. Additionally, cost-effectiveness studies are needed to establish the sustainability of new strategies of patient-centered care for [obstructive sleep apnea],” the researchers wrote.
The multicenter, randomized controlled trial included 306 patients (median age, 61.3 years; 74% men) with a BMI of 32 kg/m2 and an apnea-hypopnea index of 46 events per hour seen at 32 centers in France. To qualify for inclusion, patients had to have severe obstructive sleep apnea and suffer from at least one cardiovascular disease or have an elevated cardiovascular risk assessed by the 10-year risk for fatal cardiovascular event Systematic Coronary Risk Evaluation calculation established specifically for European countries. – by Melissa Foster
Disclosure: The study was funded by an unrestricted grant from a consortium of home care providers (ADIR Assistance, Agiradom, IPS, ISIS Medical, LINDE, LVL Medical, SOS Oxygen and Vitalaire) and CPAP companies (Breas, Philips, Resmed and Sefam). Please see the study for a full list of the authors’ relevant financial disclosures.