Authors (including presenting author) :
Lai A (1)(2)(3), Lit M (4), Lui M (3), Chu PY (3), Chan J (4), Ip M (2)
Affiliation :
(1) School of Nursing and Health Sciences, Hong Kong Metropolitan University (2) Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong (3) Department of Medicine, Queen Mary Hospital (4) Department of Medicine, Queen Elizabeth Hospital
Keyword 2: :
Self-management
Keyword 3: :
Cardiovascular risk
Keyword 4: :
Randomized controlled trial
Introduction :
Integrating lifestyle modifications with strategies to enhance Positive Airway Pressure (PAP) therapy adherence, supported by smartphone-based technology, offers a personalized care model for managing obstructive sleep apnea (OSA).
Objectives :
To evaluate the effect of the Smart Sleep Apnea Self-Management Support Program (4S) combined with usual care (UC), compared to general health information (GH) plus UC, on improving apnea severity and cardiovascular risk in OSA subjects.
Methodology :
A pragmatic randomized controlled trial recruited 123 overweight, inactive subjects with moderate-to-severe OSA (mean age 60 years) from outpatient clinics of two regional hospitals. Participants were randomly assigned to a control group receiving UC plus GH (n=59) or an intervention group receiving UC plus the 4S (n=64). The 4S program included two brief motivational interviewing sessions, theory- and theme-based instant messaging (including 2-minute OSA-related video messages and interactive personalized messages), phone calls, and an e-platform for goal setting over 12 months. Outcomes, including apnea severity (primary), health-related cognition, PAP adherence, cardiovascular risk factors, and quality of life, were assessed at baseline, 4 months, and 12 months.
Result & Outcome :
The intervention group showed significantly greater improvements than the control group throughout the study. Improvements included significantly higher PAP adherence (threefold increase in users, P< 0.001; daily usage: +1.2 hours/day, P< 0.001); health-related cognition (outcome expectancies: +0.2 units, P=0.01; treatment self-efficacy: +0.23 units, P=0.01); reductions in cardiovascular risks (body weight: -1.65 kg, P< 0.001; waist circumference: -1.83 cm, P< 0.001; neck circumference: -0.46 cm, P=0.04; full body fat: -1.06%, P=0.04; trunk fat: -2.45%, P< 0.001; systolic blood pressure: -4.08 mmHg, P< 0.001; triglycerides: -0.17 mmol/L, P=0.02); reductions in insomnia scores (-0.9 units, P=0.04); and better sleep functional outcomes (+0.46 units, P=0.02). For newly diagnosed OSA subjects, the intervention group reported significantly greater improvements in all sleep parameters than the control group (all P< 0.05). At 12 months, feedback from interviews with participants in the intervention group highlighted that tailored, practical content and simple video messages supported adherence to a healthy diet. Flexibility, regular feedback, and easy activities (e.g., walking) encouraged exercise. Personalized messages, phone support, and practical PAP tips improved adherence. Barriers included unhealthy habits, emotional eating, social influences, time constraints, physical limitations, machine noise, and travel disruptions to healthy behaviors and PAP use. The 4S program significantly improved PAP adherence, cardiovascular health, and quality of life, proving to be a sustainable and effective approach for managing OSA
