Abstract Introduction In Japan, continuous positive airway pressure (CPAP) users have traditionally been required to attend periodic in-person visits for reimbursement. Since 2018, remote monitoring systems that collect cloud-based adherence data have been reimbursed. In 2024, real-time online video consultations for CPAP management also became reimbursed, but their uptake remains limited due to concerns about reduced adherence. Evidence combining online consultations with remote monitoring in Japan is extremely scarce. We therefore conducted a pilot study to evaluate whether transitioning to an online-based follow-up model affects adherence in patients who originally demonstrated stable CPAP use. Methods We retrospectively analyzed adult CPAP users at a single sleep clinic who received alternating in-person and online follow-up every three months. The index date was defined as initiation of online follow-up. Collected variables included age, sex, BMI, AHI by PSG, CPAP usage duration, and residual AHI. Adherence during the three-month period before and after online initiation was compared. Co-primary outcomes were (1) percentage of nights with ≥4 hours of use and (2) mean daily usage time (hours). Exploratory non-inferiority analyses were performed with margins of −10 percentage points for ≥4-hour use and −0.5 hours for mean daily usage. Results Twenty-eight patients (mean age 50.2±11.8 years; 24 men; mean BMI 29.2±5.9 kg/m2; AHI by PSG.2±26.7 events/h) were included. CPAP had been used for a mean of 5.1±5.4 years. Baseline adherence was high (pre-online ≥4-hour use 81.5±20.1%; mean daily usage 5.65±1.14 h). After the introduction of online follow-up, no significant decline in adherence was observed: ≥4-hour use 83.0±18.2% (p=0.30 vs pre) and mean daily usage 5.73±1.12 h (p=0.36). Residual AHI remained low and stable (2.04±1.53 vs 2.07±1.55 events/h; p=0.77). The 95% confidence intervals for the pre–post differences did not cross the non-inferiority margins, suggesting maintained adherence in this pilot cohort. Conclusion In this single-center pilot study, a hybrid model combining online consultations with remote CPAP monitoring did not reduce adherence among patients with initially good usage patterns. This approach may reduce patient travel burden and help reallocate clinical resources toward patients with poor adherence. Larger multicenter studies are warranted to confirm these findings. Support (if any)
Nakamura et al. (Fri,) studied this question.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: