William Hevener, Bretton Lane, Simba Nyanhongo, Dominic Munafo

Sleep, Volume 46, Issue Supplement_1, May 2023, Page A231, https://doi.org/10.1093/sleep/zsad077.0524

Published: 29 May 2023

Abstract

Introduction

CPAP/APAP therapy remains the gold standard for treating OSA. Unfortunately, many patients struggle with long term CPAP/APAP adherence. Patients frequently have only 90 days to meet Medicare criteria for adherence to assure coverage of their CPAP/APAP therapy. Lack of adherence often leads to reevaluation, and a new trial of CPAP/APAP. Despite all of these efforts a significant number of patients are ultimately unsuccessful. When this process is drawn out over many months it can drain resources, time and patient motivation. We sought to determine if we could, during the first 30 days of CPAP/APAP therapy, identify those patients who were ultimately going to be unsuccessful.

Methods

A retrospective data analysis was completed on 7498 CPAP/APAP naive patients who began CPAP/APAP therapy in 2020-2021 with ResMed devices. Data was analyzed for percent of days with adherence (>4h/night) at 30 days, 60 days, 90 days, 180 days and 365 days. Additionally, AHI, sex, state, number of mask refits, and payor type (HMO, Medicare, self-pay, Medicare Advantage and Medicaid Advantage) were examined.

Results

Patients were 68% male. The age was 55.1±14.0 and AHI 29.8±25 (mean±SD). 1157 of the patients were < 10% adherent to CPAP/APAP (no more than 3 days >4h) during the first 30 days. Of the 1157, only 312 patients (27%) showed any use over 4h. The remaining 845 (73%) showed no CPAP/APAP use >4h during the first 30 days. At one year only 220 patients (19%) of the original 1157 showed any use over 4h. Of the 220 patients who showed any use >4h at year one, 83% were in the original 312 who showed any use >4h at 30 days. The other variables analyzed including AHI, sex, state, number of mask refits, and payor type were not independent predictors of long term adherence.

Conclusion

Patients with < 10% adherence at 30 days were unlikely to achieve adherence during one year of follow up. Identifying and intervening early in this population may facilitate ultimate CPAP/APAP adherence or the successful initiation of alternative therapies.