Journal Article

Management and Treatment of Patients With Obstructive Sleep Apnea Using an Intelligent Monitoring System Based on Machine Learning Aiming to Improve Continuous Positive Airway Pressure Treatment Compliance: Randomized Controlled Trial

Vaca, Rafaela, Cortijo, Anunciación, Vargiu, Eloisa, Dalmases, Mireia, Blanco, Jordi, de Batlle, Jordi, Rafael-Palou, Xavier, Moncusí-Moix, Anna, Mayoral, Ana, Barbé, Ferran, Turino, Cecilia, Pascual, Lydia, Lopera, Alejandro, Benítez, Ivan D

2021

Overview

Background: Continuous positive airway pressure (CPAP) is an effective treatment for obstructive sleep apnea (OSA), but treatment compliance is often unsatisfactory. Objective: The aim of this study was to assess the effectiveness and cost-effectiveness of an intelligent monitoring system for improving CPAP compliance. Methods: This is a prospective, open label, parallel, randomized controlled trial including 60 newly diagnosed patients with OSA requiring CPAP (Apnea–Hypopnea Index [AHI] >15) from Lleida, Spain. Participants were randomized (1:1) to standard management or the MiSAOS intelligent monitoring system, involving (1) early compliance detection, thus providing measures of patient’s CPAP compliance from the very first days of usage; (2) machine learning–based prediction of midterm future CPAP compliance; and (3) rule-based recommendations for the patient (app) and care team. Clinical and anthropometric variables, daytime sleepiness, and quality of life were recorded at baseline and after 6 months, together with patient’s compliance, satisfaction, and health care costs. Results: Randomized patients had a mean age of 57 (SD 11) years, mean AHI of 50 (SD 27), and 13% (8/60) were women. Patients in the intervention arm had a mean (95% CI) of 1.14 (0.04-2.23) hours/day higher adjusted CPAP compliance than controls (P=.047). Patients’ satisfaction was excellent in both arms, and up to 88% (15/17) of intervention patients reported willingness to keep using the MiSAOS app in the future. No significant differences were found in costs (control: mean €90.2 (SD 53.14) (US $105.76 [SD 62.31]); intervention: mean €96.2 (SD 62.13) (US $112.70 [SD 72.85]); P=.70; €1=US $1.17 was considered throughout). Overall costs combined with results on compliance demonstrated cost-effectiveness in a bootstrap-based simulation analysis. Conclusions: A machine learning–based intelligent monitoring system increased daily compliance, reported excellent patient satisfaction similar to that reported in usual care, and did not incur in a substantial increase in costs, thus proving cost-effectiveness. This study supports the implementation of intelligent eHealth frameworks for the management of patients with CPAP-treated OSA and confirms the value of patients’ empowerment in the management of chronic diseases. Trial Registration: ClinicalTrials.gov NCT03116958; https://clinicaltrials.gov/ct2/show/NCT03116958

• Publisher: Gunther Eysenbach MD MPH, Associate Professor,JMIR Publications
• Subject: Chronic illnesses / Clinical trials / Compliance / Continuous positive airway pressure / Cost analysis / Costs / Effectiveness / Empowerment / Feedback / Health care expenditures / Health services / Hypertension / Implementation / Intelligence / Intervention / Machine learning / Management / Medical treatment / Monitoring systems / Multimedia / Nasal continuous positive airway pressure / Newly diagnosed / Obstructive sleep apnea / Original Paper / Patient compliance / Patient satisfaction / Patients / Quality of life / Registration / Satisfaction / Simulation / Sleep / Sleep apnea / Sleepiness / Teams / Treatment compliance / Websites / Women