The objective of this study was to compare continuous positive airway pressure (CPAP) use, functional status, and client satisfaction in obstructive sleep apnea syndrome (OSAS) patients randomized to either telemedicine support or traditional care. In our university-affiliated sleep disorders center, patients with OSAS who were initiating CPAP therapy were randomized to receive telemedicine support vs traditional follow-up care for 30 days. The telemedicine group received a "Health Buddy" computer that provided daily Internet-based informational support and feedback for problems experienced with CPAP use. At 30 days, there were no significant differences in the hours of CPAP use between groups receiving traditional care (M = 4.22, SD+/-2.05) and telemedicine support (M = 4.29, SD+/-2.15), p = 0.87, or in the proportion of nights with CPAP use between the traditional (M = 50%+/-33.8) and telemedicine groups (M = 47%+/-34.2), p=0.61. No significant differences were found between groups in functional status (M = 2.27+/-4.56 vs M = 2.03+/-3.88, respectively, p = 0.76) or client satisfaction (M = 28.0+/-3.51 vs M = 28.5+/-3.05, p = 0.43). Patients in the telemedicine and traditional groups had similar CPAP use, functional status, and client satisfaction. The data suggest that telemedicine support as provided by our model compares favorably with traditional care. As a provider-extender, telemedicine support for patients initiating use of CPAP may allow for greater practice efficiency while maintaining quality of care.