Coexisting obstructive sleep apnea (OSA) and insomnia, termed COMISA, is clinically prevalent but frequently underdiagnosed. Although non-invasive positive pressure ventilation (NPPV) is the first-line treatment for OSA, patients with COMISA often show poor adherence to NPPV due to difficulty falling asleep and intolerance to the mask or airflow. Eszopiclone improves insomnia and shortens sleep latency, thus potentially enhancing initial NPPV adherence. Telemedicine management overcomes geographical barriers, enables dynamic adjustment of ventilator parameters, and facilitates long-term follow-up.

To investigate the effect of telemedicine management combined with eszopiclone on NPPV adherence in patients with COMISA.

Patients who attended the Sleep Center and Physical Examination Center of Sichuan Provincial Fourth People's Hospital from January to October 2024 were enrolled. After completing questionnaire assessments and polysomnography, those who met the diagnostic criteria for COMISA and agreed to receive NPPV were randomly assigned to either an experimental group or a control group. The experimental group received telemedicine-supported NPPV pressure titration and treatment, plus oral eszopiclone for 4 weeks before bedtime. The control group received in-hospital manual NPPV pressure titration and routine outpatient card-reading follow-up. Both groups were followed for 3 months. The Pittsburgh Sleep Quality Index (PSQI), Self-Rating Scale of Sleep (SRSS), and Epworth Sleepiness Scale (ESS) were recorded at baseline and at 3 months. NPPV adherence parameters (nightly use hours, percentage of days of use relative to total days, percentage of days with ≥4 hours of use, 95th percentile pressure, residual AHI, and air leak) were automatically collected via the ventilator cloud platform at 1 week, 1 month, and 3 months. Repeated-measures analysis of variance (ANOVA) was used to compare changes over time between groups, and paired t-tests were used to compare pre- and post-treatment scores within groups.

A total of 83 patients with confirmed COMISA (43 in the experimental group, 40 in the control group) were included. During the 3-month treatment period, the experimental group showed significantly better outcomes than the control group in NPPV use hours, percentage of days of use (both total days and days with ≥4 hours), post-treatment AHI, and air leak (all adjusted P<0.017). Regarding sleep scales, at 3 months the experimental group had significant reductions from baseline in PSQI (P=0.022), SRSS (P<0.001) and ESS (P=0.041), whereas the control group showed a reduction only in PSQI (P=0.001) and SRSS (P=0.036). Between-group comparisons revealed lower PSQI (P<0.001) and ESS (P=0.016) scores in the experimental group than in the control group; no significant between-group difference was observed in SRSS scores (P>0.05). The incidence of eszopiclone-related adverse events in the experimental group was 25.6% (11/43), all events were mild to moderate, with no serious adverse events or signs of respiratory depression. All patients in the experimental group were successfully connected to the telemedicine platform, and a total of 3 280 automatic data uploads were completed.

Telemedicine management combined with eszopiclone effectively improves NPPV adherence, sleep quality in patients with COMISA. This integrated approach offers a novel strategy for the comprehensive management of this population.