Telemedicine interventions for CPAP adherence in obstructive sleep apnea patients: Systematic review and meta-analysis

Sleep Med Rev. 2021 Dec:60:101543. doi: 10.1016/j.smrv.2021.101543. Epub 2021 Aug 31.


Continuous positive airway pressure (CPAP) is the preferred therapy in patients with obstructive sleep apnea (OSA). However, data suggests treatment adherence is low. In recent years, telemedicine-based intervention (TM) has been evaluated to increase adherence. In this systematic review and meta-analysis of randomized controlled trials (RCTs), we evaluated the efficacy of TM on CPAP adherence in patients with OSA. Two independent reviewers explored five databases; the risk of bias (RoB) was evaluated using the Cochrane tool. Outcomes were defined as the mean difference (MD) in CPAP use per night and the proportion of patients with increased CPAP adherence of ≥4 h/night. The meta-analysis was conducted following the DerSimonian-Laird method, and the certainty of the evidence was rated according to GRADE. We included 16 RCTs including 3039 participants. The RoB was low in 12/16 studies. TM was associated with an increase in CPAP adherence of 29.2 min/night, I2 =75% (p < 0.01), and CPAP adherence ≧4 h/night, RR: 1.09 (1.02-1.17), I2 =22%. Subgroup analyses reported better results between three and 6 months, in the sleepy subgroup. Finally, based on the results obtained in this systematic review, there is favorable evidence regarding the treatment with TM in patients with OSA using CPAP. REVIEW REGISTRATION NUMBER: CRD42020165367.

Keywords: Continuous positive airway pressure; Hypoxia; Non-invasive mechanical ventilation; Obstructive sleep apnea.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Continuous Positive Airway Pressure / methods
  • Humans
  • Patient Compliance
  • Sleep Apnea, Obstructive* / therapy
  • Telemedicine* / methods
  • Treatment Adherence and Compliance
  • Wakefulness