1235 Effect of Remote Patient Monitoring on CPAP Adherence and Patient-Reported Outcomes in Obstructive Sleep Apnea: A Comparative Study

Abstract Introduction Obstructive sleep apnea affects nearly one billion adults worldwide and is associated with hypertension, diabetes, and cardiovascular disease when untreated. Continuous positive airway pressure (CPAP) therapy is the gold standard, but its efficacy is limited by poor adherence. Remote patient monitoring (RPM) has shown promise for improving CPAP adherence, but high-quality evidence remains limited. Methods We conducted a prospective, open-label, active-comparator, randomized trial evaluating an RPM program versus standard of care (SOC) for adults aged ≥18 years who were CPAP-naive and owned a smartphone. Participants were randomized 1:1 to receive either SOC (CPAP therapy and structured coaching program) or RPM (web-based application monitored CPAP therapy and coaching). The primary endpoint was Medicare-defined CPAP adherence (>70% of nights with >4 hours of use within a consecutive 30-day period within the first 90 days). Secondary endpoints included adherence rates, mask-leak days, patient satisfaction (using a Likert scale), and sleep quality measures at 30, 60, and 90 days. Statistical significance was set at p< 0.05. Results In total, 1459 patients were approached, 330 met the inclusion criteria, 200 consented, and 196 patients (98 per group) had complete data collected. Participants were 65% male, median (interquartile range) age of 51(41-62) years, an apnea–hypopnea index of 22(14-38), and a body mass index of 32(29-37) kg.m2. Medicare-defined CPAP adherence was not statistically higher in the RPM versus the SOC group (80.6% vs 73.5%, p=0.308). However, RPM demonstrated trends toward better adherence in 60 days (80% vs 73%, p=0.086) and 90 days (77% vs 67%, p=0.140). RPM achieved significantly fewer mask leak days at 90 days (11.2 vs 14.5 days, p=0.009) and significantly higher Likert-scale patient satisfaction scores on: 1) timely response for support (p=0.042); 2) met expectations for the coaching program (p=0.033); and 3) satisfactory issue resolution (p=0.036). Conclusion Although RPM did not significantly increase Medicare-defined CPAP adherence, there was a trend towards improvement across all primary and secondary endpoints. This study may have been underpowered to detect significant differences. The RPM cohort showed reduced mask leaks and improved patient-reported experience, suggesting that RPM enhanced specific aspects of CPAP therapy management. Support (if any)