Philips Respironics has included wireless connectivity in its CPAP (continuous positive airway pressure) machines for people with obstructive sleep apnea for going on four years now. The machines have transmitted data to healthcare providers who could remotely check-in on their patients and make adjustments to their machines and therapy as needed. With the launch of a new app, called SleepMapper, Philips Respironics is making some of the data that the CPAP machines track available directly to patients for the first time.
"Adherence rates for all sorts of medical recommendations are suboptimal, generally," Mark Aloia, PhD, Senior Director, Global Clinical Research, Office of Medical and Health Affairs at Philips Healthcare told MobiHealthNews in an interview. "Adherence to CPAP [therapy] is typically poorer than others. Asking people to change how they are going to sleep is challenging."
Untreated obstructive sleep apnea can cause excessive daytime sleepiness, mood changes, and impaired concentration and memory. It can also lead to hypertension, cerebrovascular disease and cardiovascular disease. CPAP therapy is delivered via a face mask that delivers positive air pressure to the upper airway -- basically, blowing air into the person's nose -- in an attempt to prevent the upper airway from collapsing during sleep, which is what causes the obstruction.
Fewer than half of those patients prescribed CPAP continue to use it after the first year and an oft-cited study from 1993 found that the majority of CPAP users don't use it as prescribed. Still, symptoms can improve if patients use CPAP for about 4.5 hours a night.
One of the core aims of the new, free SleepMapper app, available for both Apple iOS and Android devices, is to help patients to use their CPAP machines as recommended. Aloia said the app's behavior change methods are based on an established protocol called Motivational Enhancement Therapy.
"Briefly, patients are approached in a non-directive manner with knowledge and acceptance that they might be ambivalent about making a commitment to the treatment," according to a 2010 report from Respironics. "The goal is to promote patient thought about the treatment ambivalence the patient might be feeling and sway the decisional balance toward the benefits of using the treatment. Enhancing self-confidence about therapy use is a strong predictor of long-term adherence. Studies corroborate that MET can be an effective method to improve PAP adherence, especially in patients who do not have a profound negative response to PAP."
The SleepMapper app aims to help answer questions new CPAP patients might have about their machines early on and help them get more confident about how to use their device each night. Aloia said confidence is one of the largest predictors for adherence. SleepMapper also helps patients set reachable goals to help them do the best they can each night, Aloia said. These goals are suggested by Respironics automatically through the app based on the patient's past adherence rates.
The CPAP machine can inform patients on how many hours they managed to use it the night before, how many episodes of obstructed breathing they had during the night, and whether their mask might be leaking and, therefore, not affectively delivering enough air to keep their air passageway open.
"Most importantly, this is not just about having the data, but getting the right data back to the right patient at the right time," Aloia said. "What I see happening in the field of health and technology is that many startups offering wearable remote monitoring devices are feeding data back to people ad nauseum."
Aloia said that Respironic's approach with SleepMapper is different because it aims to provide feedback at the teachable moments when the patient might be most willing to receive information that could lead to behavior change. For example, when patients are being adherent SleepMapper asks them to explain in their own words what is motivating them. When Respironics finds that the patient is no longer using their device as recommended, the app can send them an alert to remind them what had motivated them previously -- in their own words.We give them access to show them how they are using. They do it to try to change behavior. We give them access to their data but what the app speaks to them about depends on how they behave.
Aloia also said that while an app like this can only help improve adherence and isn't going to hurt anyone, Respironics is taking the extra step to conduct a clinical trial to determine its efficacy anyway. That trial is just getting underway now, he said.
"The intention here is to help patients help themselves through this complex therapy," he said, "and give them the tools that they need to make decisions on their own based on their actual capabilities."