Eight million people in the UK have obstructive sleep apnoea, and nearly two-thirds of them stop using their CPAP machine within three months of starting treatment. This matters because untreated sleep apnoea raises the risk of heart attacks, strokes, diabetes, dementia, and driving accidents. The NHS sleep services are already overloaded and cannot give every patient the behavioural support that trials have shown improves CPAP use. Existing effective therapies—psychological coaching, extra staff calls, education—are too expensive or impractical for health systems to adopt at scale. The researchers have developed a behavioural-supportive-educational intervention called GrEaTEST-OSA, co-designed with over 650 patients. They now plan to turn it into a smartphone app called CPAP Buddy. Over two development phases, they will refine the app with feedback from 72 NHS patients, then test it against usual care in 54 patients to measure study drop-out rates. If successful, CPAP Buddy could give patients the confidence and support to stick with treatment without requiring extra NHS staff time. That would free clinicians to focus on patients who cannot use digital devices, reduce hospital costs from untreated complications, and lower death rates—all through a tool that costs little to distribute.
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What problems are we trying to address? Obstructive Sleep Apnoea (OSA) is the most common sleep condition, affecting approximately eight million people in the UK and one billion people worldwide (12% of these populations). Symptoms include sleepiness, fatigue, poor concentration, forgetfulness, feeling irritable, anxious, and depressed, and there is a higher chance of patients having heart attacks, strokes, diabetes, dementia, cancer, driving accidents, and of dying. Continuous Positive Airway Pressure (CPAP) is the most efficacious OSA treatment. It is a machine that blows air through a face mask worn whilst sleeping. Patients who do not use (“do not adhere” to) CPAP enough have poorer health, cost health services more, and have a higher death rate than adherent patients. Non-adherence to CPAP is very common in the UK and worldwide. We found that at five UK sleep services between 2019 and 2020, 62% (49-73%) of patients were non-adherers three months (the peak) after starting treatment. Our pilot work indicates that the problem is partly that NHS staff are too busy to help patients having difficulties with CPAP. The British Lung Foundation reported that NHS sleep services’ workloads were excessive 10 years ago; subsequently they have worsened. What is our solution? Trials demonstrate that behavioural (psychological) therapies (e.g., which increase patients’ confidence in using CPAP), some supportive interventions (e.g., extra calls from staff) and some educational interventions increase CPAP adherence. However, these therapies have been too expensive and/or impractical for health systems to adopt. We have developed an intervention combining behavioural therapy, support, and education (the Group Education and Training with Enhanced Support and behavioural Therapy (GrEaTEST-OSA) intervention) with input from over 650 patients with OSA. We now want to turn it into a smartphone/tablet/computer-based application. This behavioural-supportive-educational complex intervention delivered in an app (CIBSE-app) should be value for money and practical for NHS use and in many other healthcare systems. Our CIBSE-app is distinct meaning there is little competition. What is our aim? It is to develop ‘CPAP buddy’, the CIBSE-app, to be given to patients with/loaned a digital device when starting CPAP in the UK, and ultimately globally, to establish adherence to CPAP and reduce staff time supporting this process. Hence staff are freed to help patients starting CPAP who do not have/cannot use digital devices to foster adherence (so they are not disadvantaged). What will we do in this study? Develop the first version of CPAP buddy with five patient advisors, two of their partners, and a professional app design and development team Improve this version until we achieve an improved version that patients like and engage with, with feedback from 72 NHS patients who will use the app in their first month of CPAP therapy Test the improved version of CPAP Buddy with usual NHS care in 54 NHS patients in their first month of CPAP therapy, to find out how many patients drop-out of the study (which is needed to plan the next study) What is the next step if this study is successful? A study testing if our final improved CPAP Buddy app increases the percentage of patients adhering to CPAP and saves staff time compared to usual NHS care, and other relevant end-results e.g., money saved for the NHS. Our industry partner is advising on regulatory and commercialisation pathways to achieve patient benefit at speed.
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