Annual Versus Patient-Initiated Follow-Up in Sleep Apnoea Care: A Quasi-Experimental Study

Obstructive sleep apnoea affects nearly 1 billion people worldwide, placing increasing pressure on healthcare systems. Continuous positive airway pressure (CPAP) therapy is often the standard treatment, and efficient follow-up strategies are needed to maintain adherence and optimise hospital resources. This study aimed to evaluate whether CPAP follow-up, conducted through traditional scheduled annual in-person or patient-initiated contacts, was most effective based on adherence rates, contact type and frequency, and associated costs. A quasi-experimental design was used to compare CPAP follow-up practices in two sleep clinics. The primary outcome was adherence after 2 years, assessed using telemonitoring data from the CPAP devices. Registry data were used to assess contact frequency and type, as well as diagnosis-related group tariffs to estimate hospital contact costs. Adherence rates were 80% in both sleep clinics after 2 years. Patients with scheduled annual contacts had an average of 4.09 (SD 1.63) interactions, primarily in-person, whereas those with patient-initiated contacts had 5.09 (SD 3.01), most of which were virtual. The cost-minimisation analysis revealed no statistically significant difference in overall costs between the two follow-up models, with a mean of 1210 EUR (IQR 1129-1614) in the scheduled contact group and 1076 EUR (IQR 700-1507) in the patient-initiated group. To our knowledge, this is the first study to examine the impact of replacing scheduled CPAP follow-up contacts with patient-initiated contacts. Given the comparable adherence rates and costs, we conclude that scheduled annual in-person follow-up may be considered for replacement with a more flexible, virtual, patient-driven follow-up model.