CPAP treatment supported by telemedicine does not improve blood pressure in high cardiovascular risk OSA patients: a randomized, controlled trial

Abstract

Study objectives: Obstructive sleep apnea (OSA) has been associated with hypertension, which is one of the intermediary mechanisms leading to increased cardiovascular morbidity. This study aimed at evaluating the effects of a combination of continuous positive airway pressure (CPAP) and telemedicine support on blood pressure (BP) reduction in high cardiovascular risk OSA patients.

Design: A multi-center randomized controlled trial that compared standard CPAP care and CPAP care and a telemedicine intervention.

Setting: Sleep clinics in France.

Patients or participants: 107 adult (18-65 years old) OSA patients (AHI > 15 events/h) with a high cardiovascular risk (cardiovascular SCORE > 5% or secondary prevention).

Interventions: Patients were randomized to either standard care CPAP (n = 53) or CPAP and telemedicine (n = 54). Patients assigned to telemedicine were equipped with a smartphone for uploading BP measurements, CPAP adherence, sleepiness, and quality of life data; in return, they received pictograms containing health-related messages.

Measurements: The main outcome was home self-measured BP and secondary outcomes were cardiovascular risk evolution, objective physical activity, CPAP adherence, sleepiness and quality of life.

Results: Self-measured BP did not improve in either group (telemedicine or standard care). Patients in primary prevention showed greater BP reduction with CPAP treatment than those in secondary prevention.

Conclusions: CPAP treatment supported by telemedicine alone did not improve blood pressure and cardiovascular risk in high cardiovascular risk OSA patients. This study emphasizes the need for diet and physical activity training programs in addition to CPAP when aiming at decreasing cardiometabolic risk factors in these patients.

Clinical trials registration: ClinicalTrials.gov identifier: NCT01226641.

Keywords: blood pressure; cardiovascular risk; obstructive sleep apnea; telemedicine.

Figures

Figure 1

Design of telemedicine intervention.

Figure 2

Flow chart of patient recruitment.

Figure 3

Box plots of changes in morning and evening self-measured blood pressure in telemedicine and standard care.

Figure 4

Changes in self-measured blood pressure in patients presenting primary and secondary cardiovascular risk. Dark gray line represents telemedicine and light gray standard care. * P = 0.0075.