Virginia Research Day 2021

Medical Resident Research Cl inical

06 Can Patient Compliance With Continuous Positive Airway Pressure (CPAP) Be Improved?

Andrew Wyker, DO, Mary Mondul, R.EEG T, RPSGT, Kimberly Bird, MD Corresponding author: michael.moore1@LPTN.net

SOVAH Health Internal Medicine Residency Program

Introduction: Adjusting to use of CPAP for obstructive sleep apnea requires effort and lifestyle changes. It is estimated that 50% of sleep apnea patients prescribed CPAP are non-compliant with prescribed therapy one year later. Multiple strategies have been implemented to improve compliance including smaller and quieter CPAP machines, different mask types and sizes, heated humidification, mobile applications, and flexible expiratory pressures. Through increased compliance, patients benefit from better sleep, improved medical conditions such as hypertension and diabetes, and lower the risk of heart disease, stroke, cancer, and ultimately premature mortality. Methods: A retrospective study was performed which compared CPAP compliance between patients initiating CPAP with standard follow up at an American Academy of Sleep Medicine (AASM) accredited Sleep Center in 2018 versus those initiating a new team management and online cloud-

Conclusions: Data revealed that standard close follow up with an AASM accredited Sleep Center resulted in compliance that was non-inferior to team management with an online cloud-based learning program approach. Previous studies of the cloud- based management approach revealed an overall 24% increase in compliance when utilized by all physicians. Patients treated for sleep apnea by primary care physicians may benefit the most from the cloud-based program as compared to those managed by sleep specialists. A potential factor in the study’s outcome was the lack of successful patient contact during the first week in the cloud-based intervention group. In addition, both groups had patients lost to follow up after initiation of CPAP.

based learning program added to standard follow-up visits at the Center in 2019. Patients were selected at random from lists of patients requiring CPAP from both 2018 and 2019. This new 2019 program utilized CPAP Sleep Coaches and Respiratory Therapists who contacted each patient at days 3, 7, 14, 30, 45, 60, and 90 after starting CPAP to promote patient compliance. Compliance was defined based on requirements implemented by the Center for Medicare Services which include usage of CPAP at least 4 hours a night 70% of the time. Results: There were 86 patients in the 2018 control group and 86 patients in the 2019 interventional group. In the 2018 group, 36 had mild sleep apnea, 26 had moderate, and 24 had severe. In the 2019 group, 25 had mild sleep apnea, 16 had moderate, and 45 had severe. Ninety-day compliance between the 2018 and 2019 groups were 63.9% and 43.0% respectively, p value 0.005929.

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