@Article{info:doi/10.2196/24072, author="Turino, Cecilia and Ben{\'i}tez, Ivan D and Rafael-Palou, Xavier and Mayoral, Ana and Lopera, Alejandro and Pascual, Lydia and Vaca, Rafaela and Cortijo, Anunciaci{\'o}n and Moncus{\'i}-Moix, Anna and Dalmases, Mireia and Vargiu, Eloisa and Blanco, Jordi and Barb{\'e}, Ferran and de Batlle, Jordi", title="Management and Treatment of Patients With Obstructive Sleep Apnea Using an Intelligent Monitoring System Based on Machine Learning Aiming to Improve Continuous Positive Airway Pressure Treatment Compliance: Randomized Controlled Trial", journal="J Med Internet Res", year="2021", month="Oct", day="18", volume="23", number="10", pages="e24072", keywords="obstructive sleep apnea; continuous positive airway pressure; patient compliance; remote monitoring; machine learning", abstract="Background: Continuous positive airway pressure (CPAP) is an effective treatment for obstructive sleep apnea (OSA), but treatment compliance is often unsatisfactory. Objective: The aim of this study was to assess the effectiveness and cost-effectiveness of an intelligent monitoring system for improving CPAP compliance. Methods: This is a prospective, open label, parallel, randomized controlled trial including 60 newly diagnosed patients with OSA requiring CPAP (Apnea--Hypopnea Index [AHI] >15) from Lleida, Spain. Participants were randomized (1:1) to standard management or the MiSAOS intelligent monitoring system, involving (1) early compliance detection, thus providing measures of patient's CPAP compliance from the very first days of usage; (2) machine learning--based prediction of midterm future CPAP compliance; and (3) rule-based recommendations for the patient (app) and care team. Clinical and anthropometric variables, daytime sleepiness, and quality of life were recorded at baseline and after 6 months, together with patient's compliance, satisfaction, and health care costs. Results: Randomized patients had a mean age of 57 (SD 11) years, mean AHI of 50 (SD 27), and 13{\%} (8/60) were women. Patients in the intervention arm had a mean (95{\%} CI) of 1.14 (0.04-2.23) hours/day higher adjusted CPAP compliance than controls (P=.047). Patients' satisfaction was excellent in both arms, and up to 88{\%} (15/17) of intervention patients reported willingness to keep using the MiSAOS app in the future. No significant differences were found in costs (control: mean {\texteuro}90.2 (SD 53.14) (US {\$}105.76 [SD 62.31]); intervention: mean {\texteuro}96.2 (SD 62.13) (US {\$}112.70 [SD 72.85]); P=.70; {\texteuro}1=US {\$}1.17 was considered throughout). Overall costs combined with results on compliance demonstrated cost-effectiveness in a bootstrap-based simulation analysis. Conclusions: A machine learning--based intelligent monitoring system increased daily compliance, reported excellent patient satisfaction similar to that reported in usual care, and did not incur in a substantial increase in costs, thus proving cost-effectiveness. This study supports the implementation of intelligent eHealth frameworks for the management of patients with CPAP-treated OSA and confirms the value of patients' empowerment in the management of chronic diseases. Trial Registration: ClinicalTrials.gov NCT03116958; https://clinicaltrials.gov/ct2/show/NCT03116958 ", issn="1438-8871", doi="10.2196/24072", url="https://www.jmir.org/2021/10/e24072", url="https://doi.org/10.2196/24072", url="http://www.ncbi.nlm.nih.gov/pubmed/34661550" }