{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T06:20:30Z","timestamp":1790058030324,"version":"4.0.1"},"reference-count":42,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2025,7,29]],"date-time":"2025-07-29T00:00:00Z","timestamp":1753747200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Victor Babe\u0219 University of Medicine and Pharmacy","award":["40\/60\/21990\/22.09.2023"],"award-info":[{"award-number":["40\/60\/21990\/22.09.2023"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Obstructive sleep apnea (OSA) is a highly prevalent disorder that significantly impacts quality of life and daily functioning. While continuous positive airway pressure (CPAP) therapy is effective, long-term adherence remains a challenge. This single-arm observational study aimed to evaluate clinical outcomes and adherence patterns during telemedicine-supported CPAP therapy and identify distinct phenotypic response clusters in Romanian patients with OSA. Methods: This prospective observational study included 86 adults diagnosed with OSA, treated with ResMed Auto CPAP devices at \u201cVictor Babe\u0219\u201d University Hospital in Timi\u0219oara, Romania. All patients were remotely monitored via the AirView\u2122 platform and received monthly telephone interventions to promote adherence when necessary. Clinical outcomes were assessed through objective telemonitoring data. K-means clustering and t-distributed stochastic neighbor embedding (t-SNE) were employed to explore phenotypic response patterns. Results: During telemedicine-supported CPAP therapy, significant clinical improvements were observed. The apnea\u2013hypopnea index (AHI) decreased from 42.0 \u00b1 21.1 to 1.9 \u00b1 1.3 events\/hour. CPAP adherence improved from 75.5% to 90.5% over six months. Average daily usage increased from 348.4 \u00b1 85.8 to 384.2 \u00b1 65.2 min. However, post hoc analysis revealed significant concerns about the validity of self-reported psychological improvements. Self-esteem changes showed negligible correlation with objective clinical measures (r &lt; 0.2, all p &gt; 0.1), with only 3.3% of variance being explained by measurable therapeutic factors (R2 = 0.033). Clustering analysis identified four distinct adherence and outcome profiles, yet paradoxically, patients with lower adherence showed greater self-esteem improvements, contradicting therapeutic causation. Conclusions: Telemedicine-supported CPAP therapy with structured monthly interventions was associated with substantial clinical improvements, including excellent AHI reduction (22-fold) and high adherence rates (+15% after 6 months). Data-driven phenotyping successfully identified distinct patient response profiles, supporting personalized management approaches. However, the single-arm design prevents definitive attribution of improvements to telemonitoring versus natural adaptation or placebo effects. Self-reported psychological outcomes showed concerning patterns suggesting predominant placebo responses rather than therapeutic benefits. While the overall findings demonstrate the potential value of structured telemonitoring for objective CPAP outcomes, controlled trials are essential to establishing true therapeutic efficacy and distinguishing intervention effects from measurement bias.<\/jats:p>","DOI":"10.3390\/jcm14155339","type":"journal-article","created":{"date-parts":[[2025,7,29]],"date-time":"2025-07-29T09:31:45Z","timestamp":1753781505000},"page":"5339","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Telemedicine-Supported CPAP Therapy in Patients with Obstructive Sleep Apnea: Association with Treatment Adherence and Clinical Outcomes"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-0749-8232","authenticated-orcid":false,"given":"Norbert","family":"Wellmann","sequence":"first","affiliation":[{"name":"Doctoral School, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania"},{"name":"Center for Research and Innovation in Personalized Medicine of Respiratory Diseases (CRIPMRD), \u201cVictor Babes\u201d, Pneumology University Clinic, University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania"},{"name":"Pulmonology Department II, Clinical Hospital of Infectious Diseases and Pneumophthisiology, \u201cDr. Victor Babes\u201d Timisoara, Gheorghe Adam Street, No 13, 300310 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4840-1925","authenticated-orcid":false,"given":"Versavia Maria","family":"Ancusa","sequence":"additional","affiliation":[{"name":"Department of Computer and Information Technology, Automation and Computers Faculty, \u201cPolitehnica\u201d University of Timisoara, Vasile P\u00e2rvan Blvd, No. 2, 300223 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1160-9164","authenticated-orcid":false,"given":"Monica Steluta","family":"Marc","sequence":"additional","affiliation":[{"name":"Center for Research and Innovation in Personalized Medicine of Respiratory Diseases (CRIPMRD), \u201cVictor Babes\u201d, Pneumology University Clinic, University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania"},{"name":"Pulmonology Department II, Clinical Hospital of Infectious Diseases and Pneumophthisiology, \u201cDr. Victor Babes\u201d Timisoara, Gheorghe Adam Street, No 13, 300310 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5270-1464","authenticated-orcid":false,"given":"Ana Adriana","family":"Trusculescu","sequence":"additional","affiliation":[{"name":"Center for Research and Innovation in Personalized Medicine of Respiratory Diseases (CRIPMRD), \u201cVictor Babes\u201d, Pneumology University Clinic, University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania"},{"name":"Pulmonology Department II, Clinical Hospital of Infectious Diseases and Pneumophthisiology, \u201cDr. Victor Babes\u201d Timisoara, Gheorghe Adam Street, No 13, 300310 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7573-3714","authenticated-orcid":false,"given":"Camelia Corina","family":"Pescaru","sequence":"additional","affiliation":[{"name":"Center for Research and Innovation in Personalized Medicine of Respiratory Diseases (CRIPMRD), \u201cVictor Babes\u201d, Pneumology University Clinic, University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania"},{"name":"Pulmonary Rehabilitation Center, Clinical Hospital of Infectious Diseases and Pulmonology, \u201cDr. Victor Babes\u201d Timisoara, Gheorghe Adam Street, No. 13, 300310 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Flavia Gabriela","family":"Martis","sequence":"additional","affiliation":[{"name":"Doctoral School, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania"},{"name":"Center for Research and Innovation in Personalized Medicine of Respiratory Diseases (CRIPMRD), \u201cVictor Babes\u201d, Pneumology University Clinic, University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania"},{"name":"Pulmonology Department II, Clinical Hospital of Infectious Diseases and Pneumophthisiology, \u201cDr. Victor Babes\u201d Timisoara, Gheorghe Adam Street, No 13, 300310 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioana","family":"Ciortea","sequence":"additional","affiliation":[{"name":"Doctoral School, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-6020-4593","authenticated-orcid":false,"given":"Alexandru Florian","family":"Crisan","sequence":"additional","affiliation":[{"name":"Pulmonary Rehabilitation Center, Clinical Hospital of Infectious Diseases and Pulmonology, \u201cDr. Victor Babes\u201d Timisoara, Gheorghe Adam Street, No. 13, 300310 Timisoara, Romania"},{"name":"Research Center for the Assessment of Human Motion, Functionality and Disability (CEMFD), \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2112-2923","authenticated-orcid":false,"given":"Adelina","family":"Maritescu","sequence":"additional","affiliation":[{"name":"Doctoral School, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania"},{"name":"Pulmonary Rehabilitation Center, Clinical Hospital of Infectious Diseases and Pulmonology, \u201cDr. Victor Babes\u201d Timisoara, Gheorghe Adam Street, No. 13, 300310 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madalina Alexandra","family":"Balica","sequence":"additional","affiliation":[{"name":"Doctoral School, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania"},{"name":"Infectious Diseases University Clinic, Department of Infectious Diseases, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9034-5218","authenticated-orcid":false,"given":"Ovidiu","family":"Fira-Mladinescu","sequence":"additional","affiliation":[{"name":"Center for Research and 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