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Background Chronic hypercapnic respiratory failure in patients with Obstructive Sleep Apnoea/Obesity Hypoventilation Syndrome (OSA/OHS) is commonly treated with non-invasive ventilation (NIV). However, adherence to NIV can be challenging, with substantial non-compliance occurring due to factors such as discomfort, aerophagia and claustrophobia. The primary aims of this study were-to assess whether remote monitoring could improve and optimise NIV adherence, to test patients‘ willingness to use remote monitoring devices, and to evaluate the associated healthcare resource usage and improvement in symptoms.Methods The READ-NIV trial was a prospective, randomised, and controlled (usual care) trial with a two-arm parallel group design, testing remote monitoring of home NIV (T4P device, SRETT, Paris, France) for 3 months in patients with OSA/OHS who have previously had low NIV adherence (<4 hours/night). The trial was approved by the research ethics committee/Health Research Authority (HRA) [Integrated Research Application System (IRAS) ID: 270108], as well as by Guy’s & St Thomas’ NHS Foundation Trust R&D Department The study was registered at ClinicalTrials.gov ( NCT04884165).Results A total of 32 participants were enrolled and randomly assigned to intervention (n=16) or to usual care (n=16). Both study arms were similar in terms of age 61.5 (49.2; 70.2) vs 66.5 (51.0; 71.0) years, gender (male: female, 10:6 vs 11:5) and body mass index, BMI 37.7 (34.0 ;48.4) vs 42.8 (39.7; 48.2) kg/m2. In the intervention arm, ΔNIV usage was +0.3 hours (95% CI -0.1; 3.2) hours/night; p=0.48). In the control arm, ΔNIV usage was +0.5 hours (95% CI -0.5; 2.0); p=0.32). The difference in NIV usage between groups at 12 weeks was not significant: -0.2 hours (95% CI: -2.3; 2.0) hours/night; p=0.90). Quality of life outcomes did not differ significantly between the intervention and usual care arms at the end of the trial.Conclusion This randomised controlled trial aimed to improve adherence over 12 weeks using remote monitoring of NIV in patients with OSA/OHS. The intervention was associated with a modest but non-significant increase in adherence. These findings highlight the challenges of remote monitoring of patients with low long-term adherence.