Currently submitted to: Interactive Journal of Medical Research
Date Submitted: Jul 20, 2026
Open Peer Review Period: Jul 29, 2026 - Sep 23, 2026
(currently open for review)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Telemedicine Interventions to Improve Continuous Positive Airway Pressure Adherence in Patients With Obstructive Sleep Apnea: Updated Systematic Review and Meta-Analysis
ABSTRACT
Background:
Background:
Although previous meta-analyses have suggested that telemedicine improves continuous positive airway pressure (CPAP) adherence in patients with obstructive sleep apnea (OSA), considerable heterogeneity remains, and the relative effectiveness of different telemedicine intervention strategies has not been well established.
Objective:
Objective:
This meta-analysis aimed to provide an updated evaluation of telemedicine interventions on CPAP adherence in patients with OSA and to explore the effects of intervention modality, follow-up duration, and trigger mechanisms.
Methods:
Methods:
We systematically searched the Cochrane Library, PubMed, Web of Science, and Embase databases for randomized controlled trials (RCTs) published from inception to June 2026. Studies were selected according to predefined inclusion and exclusion criteria, and their methodological quality was assessed using the Cochrane Risk of Bias tool version 2 (RoB 2.0). Statistical analyses were performed using RevMan 5.4 and Stata 19 software.
Results:
Results:
A total of 33 RCTs (4989 patients) were included. Telemedicine significantly improved mean nightly CPAP usage (WMD 0.33 hours/night, 95% CI 0.16-0.50) and percentage of days with use (WMD 4.95%, 95% CI 2.02-7.88). Benefits were concentrated within the first 3 months (WMD 0.56 hours/night, 95% CI 0.29-0.82) and were most pronounced with automated interventions (WMD 4.95%, 95% CI 2.02-7.88). No significant improvements were observed for adequate adherence rates, Epworth Sleepiness Scale (ESS) scores, or apnea-hypopnea index (AHI).
Conclusions:
Conclusions:
This updated meta-analysis indicates that telemedicine can improve objective adherence metrics for CPAP use in patients with OSA, with benefits being more pronounced during the early treatment period, and automated telemedicine interventions and trigger-based intervention models may offer additional advantages. However, the existing evidence for improvements in adequate adherence rates and clinical outcome measures (such as ESS and AHI) remains limited. Future RCTs with longer follow-up periods, standardized reporting of clinical endpoints, and head-to-head comparisons of different telemedicine modalities are warranted to determine their long-term clinical value and optimal implementation strategies. Clinical Trial: Trial Registration: PROSPERO CRD420251242243; https://www.crd.york.ac.uk/PROSPERO/view/CRD420251242243
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