The impact of different CPAP delivery approaches on nightly adherence and discontinuation rate in patients with obstructive sleep apnea
- S-Med
- 4 days ago
- 2 min read
Two findings in this study were of note. First, that adherence with PAP was less in both groups receiving direct home shipments of PAP compared to the group with standard setup in a center. These differences were not explained differences in sex, age, body mass index, OSA severity (baseline AHI), self-reported sleepiness (baseline Epworth Sleepiness Scale score), medical insurance, or mask type (although nasal masks, rather than full face masks were more commonly used). Compared to the home ship setup group, there was no worsening in adherence during the COVID-19 pandemic when choice of PAP delivery was removed. It is possible that as people became more accustomed to telehealth/video conferencing later in the pandemic that the in-person education and motivation feel of a face-to-face set-up for PAP is not as necessary to achieve optimal adherence. Prior studies have shown that intensive education or motivational enhancement helps with CPAP adherence and may be more effective in person. However, more recent studies have not shown significant drop off in adherence during the COVID-19 pandemic and thus adaptations to the delivery of CPAP or the initial setup may not be as important if the patient feels as engaged and as ready to try PAP as they would during an in-person setup.
Second, we observed that more PAP discontinuation was seen in home ship groups compared to in person group setup. Further analysis of the discontinuation group revealed similar demographics, sleepiness, and OSA severity to those who continued PAP. The reason for this finding remains unclear, but it is possible that an unidentified socioeconomic factor may explain some of the differences we saw on adherence between groups, despite similarities in demographics or insurance information. Socioeconomic factors have been identified as a predictor in prior studies and reinforce the need for potentially more intensive education, interaction by telemedicine, or quick follow up by extenders to intervene early to keep at risk patients with OSA on PAP.
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