Multimodal telemonitoring for weight reduction in sleep apnea patients: A randomized controlled trial

Chest. 2022 Aug 20:S0012-3692(22)03651-0. doi: 10.1016/j.chest.2022.07.032. Online ahead of print.

ABSTRACT

BACKGROUND: Telemonitoring the usage of continuous positive airway pressure (CPAP) devices and remote feedback on device data effectively optimizes CPAP adherence in patients with obstructive sleep apnea (OSA).

RESEARCH QUESTIONS: Can expanding the scope of telemonitoring and remote feedback to body weight (BW), blood pressure (BP), and physical activity enhance efforts for BW reduction in OSA patients receiving CPAP?

STUDY DESIGN AND METHODS: Participants were recruited from patients at 16 sleep centers in Japan with OSA and obesity who were on CPAP. Obesity was defined as a body mass index (BMI) ≥25 kg/m², based on Japanese obesity guidelines. Implementation of CPAP telemonitoring was enhanced with electronic scales, blood pressure monitors, and pedometers that could transmit data from devices wirelessly. Participants were randomized to the Multimodal-telemonitoring group or the Usual-CPAP-telemonitoring group and were followed for 6 months. Attending physicians provided monthly telephone feedback calls to the Usual-CPAP-telemonitoring group on CPAP data obtained remotely. In the Multimodal-telemonitoring group, physicians additionally encouraged participants to reduce their BW, after sharing the remotely obtained data on BW, BP, and step count. The primary outcome was set as ≥3% BW reduction from baseline.

RESULTS: One hundred and sixty-eight participants (BMI, 31.7±4.9 kg/m²) completed the study, and ≥3% BW reduction occurred in 33/84 (39.3%) and 21/84 (25.0%) participants in the Multimodal-telemonitoring and Usual-CPAP-telemonitoring groups, respectively (p=0.047). While no significant differences were found between the two groups in the change in office and home BP, daily step counts during the study period were significantly higher in the Multimodal-telemonitoring group than in the Usual-CPAP-telemonitoring group (4,767 (2,864-6,617) vs. 3,592 (2,117-5,383) /day, p=0.02) INTERPRETATION: Multimodal telemonitoring may enhance BW reduction efforts in patients with OSA and obesity.

CLINICAL TRIAL REGISTRATION NUMBER: UMIN000033607 (www.umin.ac.jp/ctr/index.htm).

PMID:35998706 | DOI:10.1016/j.chest.2022.07.032