0523 CPAP ADHERENCE IN SLEEP APNEA MANAGED WITH VIRTUAL CARE AND EHR INTEGRATION

Abstract

CPAP has a track record of high abandonment and suboptimal use. This report examines 6 month measures of disease control, CPAP use and CPAP abandonment in sleep apnea patients in a health care system employing wireless daily data transfer incorporated with EHR-integration and structured virtual care over a 3 year time period. Study participants. Consecutive patients with obstructive sleep apnea (N=1,530), ≥18 years of age with AHI≥15 who identified CPAP as primary therapy and used it for at least 6 months were included (baseline AHI: 50 ± 31, BMI: 37 ± 8, Epworth Sleepiness Scale score: 10 ± 5). Measures. Adherence was measured by average daily CPAP use in five time periods specified by days from therapy initiation* and the contribution of each period to the variation in average daily use over the entire 6 months was measured by coefficients of determination (r2). Abandonment was defined during any time period by two methods as a) average use of 0 minutes or b) all days < 20 minutes. The range of average CPAP use across all time periods was remarkably stable at 5.3–5.6 hours with and average use of 5.4 ± 2.1 hours over 6 months and 75% of patients > 4 hours with a mode at 7 hours use. Abandonment was low by both definitions and across time periods (2–6%). Less than 1% of the variation in CPAP use over 6 months could be explained by AHI, ESS, age or gender. AHI over 6 months was 3 ± 3. Variability in CPAP use over 6 months was best predicted by measures* after 60 days: 1) 27% at 1–7 days, 2) 38% at 1–14 days, 3) 52% at 1–30 days, 4) 83% at 61–90 days, 5) 78% at 151–180 days. Abandonment was low by both definitions and across time periods (2–6%). Outcome data were missing for less than 3% of the patients. Sleep apnea can be managed with EHR integration and structured virtual care with high CPAP adherence and low abandonment rates. Over 6 months observation, prediction of average CPAP use improves with continuous monitoring, peaking after 60 days use. Fairview Health System.