Effect of Remote Patient Monitoring on PAP Adherence and Patient-Reported Outcomes in Obstructive Sleep Apnea: A Comparative Study
Ricardo De Armas, Edward Mezerhane, Aron Bobrowski, Francesca Barnes, William Hevener, Bretton Lane, Betsy Dauphin, Christy Guerrero, Geoff Eade, Dominic Munafo
Sleep and Breathing, Volume 30, Article 304 (2026), https://doi.org/10.1007/s11325-026-03851-4
Published: November 5, 2026
Abstract
Purpose
Obstructive sleep apnea (OSA) is a common condition, and positive airway pressure (PAP) is the standard therapy; however, its effectiveness depends on adherence. Remote patient monitoring (RPM) may improve PAP adherence, but evidence remains limited.
Methods
We conducted a prospective, open-label, active-comparator, randomized trial comparing an RPM program with standard of care (SOC) in PAP-naive adults (≥ 18 years) with OSA who owned a smartphone. Participants were randomized 1:1 to SOC (PAP therapy with a standard coaching program) or RPM (PAP therapy monitored through a web-based application with coaching). The primary endpoint was Medicare-defined PAP adherence (> 4 h of use on > 70% of nights during a consecutive 30-day period within the first 90 days). Secondary endpoints included nights with elevated mask leak, patient-reported sleep measures, and patient satisfaction (Likert scale), with Benjamini–Hochberg adjustment for multiple comparisons. Given the pragmatic sample size, the study was designed to estimate between-arm differences rather than to test superiority with conventional power.
Results
The 196 participants (98 per arm) were 65% male, with a median (interquartile range) age of 51 (41–62) years and body mass index of 32 (29–37) kg/m². Medicare-defined PAP adherence was 80.6% in the RPM group and 73.5% in the SOC group (difference 7.1% points; p = 0.308). At day 90, the RPM group had fewer nights with elevated mask leak (median 11.2 vs. 14.5; unadjusted p = 0.009; adjusted p = 0.113) and a higher proportion of participants reporting the highest satisfaction with timeliness of support, the coaching program, and issue resolution (unadjusted p = 0.031–0.044). None of these differences remained significant after adjustment for multiple comparisons (all adjusted p ≥ 0.11).
Conclusions
Because of the limited sample size, conclusions are primarily descriptive. Medicare-defined PAP adherence did not differ significantly between RPM and SOC. The RPM group had fewer nights with elevated mask leak and higher satisfaction scores, but these differences were not significant after adjustment for multiple comparisons and require confirmation in an adequately powered trial.