Way to Health

Way to Sleep

Improve adherence and functional outcomes of adults adults with Obstructive Sleep Apnea (OSA) using daily Web-based access to their positive airway pressure (PAP) with or without a financial incentive.

Aug 1, 2015

Samuel T. Kuna, MD Samuel T. Kuna, MD
Luqi Chi, MD Luqi Chi, MD

Background and Aim

Obstructive sleep apnea (OSA) is characterized by repetitive closure of the pharyngeal airway during sleep. OSA is prevalent and is associated with a significant increase in morbidity and mortality.

The study team tested whether providing adults with obstructive sleep apnea (OSA) with daily Web-based access to their positive airway pressure (PAP) usage over 3 mo with or without a financial incentive in the first week improves adherence and functional outcomes.

Intervention and Design

One hundred thirty-eight adults with newly diagnosed OSA starting PAP treatment were enrolled from academic- and community-based sleep centers.

Intervention - Participants were randomized to: usual care, usual care with access to PAP usage, or usual care with access to PAP usage and a financial incentive. PAP data were transmitted daily by wireless modem from the participants’ PAP unit to a website where hours of usage were displayed. Participants in the financial incentive group could earn up to $30/day in the first week for objective PAP use ≥ 4 h/day.

Main Outcomes and Measures - Primary analyses were focused on examining potential group differences in: (1) mean hours of daily PAP use (all days); (2) mean hours of daily PAP use on days used; and (3) changes in FOSQ-10 scores (baseline to 3 mo). Secondary outcomes included subjective functional outcomes measures (e.g., ESS, and SF-12) as well as mean AHIFLOW, and mean air leak from the circuit.

Way to Health Use

Findings and Conclusions

Mean hours of daily PAP use in the two groups with access to PAP usage data did not differ from each other but was significantly greater than that in the usual care group in the first week and over 3 mo (P < 0.0001). Average daily use (mean ± standard deviation) during the first week of PAP intervention was 4.7 ± 3.3 h in the usual care group, and 5.9 ± 2.5 h and 6.3 ± 2.5 h in the Web access groups with and without financial incentive respectively. Adherence over the 3-mo intervention decreased at a relatively constant rate in all three groups. Functional Outcomes of Sleep Questionnaire change scores at 3 mo improved within each group (P < 0.0001) but change scores of the two groups with Web access to PAP data were not different than those in the control group (P > 0.124).

Positive airway pressure adherence is significantly improved by giving patients Web access to information about their use of the treatment. Inclusion of a financial incentive in the first week had no additive effect in improving adherence.

Publications and Press

  • Web-Based Access to Positive Airway Pressure Usage with or without an Initial Financial Incentive Improves Treatment Use in Patients with Obstructive Sleep Apnea