0565 The Obstructive Sleep Apnea CPAP Therapy Compliance; Progressions, Challenges and Interventions

Abstract

Abstract Introduction Obstructive sleep apnea (OSA) is a common sleep disorder affecting 26% of the United States adult population and is associated with adverse health outcomes. Despite the advent of an array of treatment options, PAP remains the primary treatment modality for OSA since the approach was introduced in 1981. The objective of this systematic review is to determine how we can increase compliance to PAP therapy as the gold standard of OSA treatment. Methods A systematic review was conducted to study meta-analyses performed to determine the clinical significance of using PAP in several modalities, PAP initiation strategies, educational and behavioral interventions, tele monitoring, humidification, level of AHI, different mask interfaces, and flexible or modified pressure profile PAP to treat OSA in adults. Results Data demonstrated a clinically significant improvement in PAP adherence with the use of educational, behavioral, troubleshooting, and telemonitoring interventions. Also systematic reviews show that nasal interfaces compared to oronasal interfaces have improved adherence and slightly greater reductions in OSA severity, heated humidification compared to no humidification reduces some continuous PAP-related side effects. Finally, AHI level of 15 and above but not demographic variables payed a role in compliance. Conclusion All medical therapies have challenges with patient adherence. PAP therapy for OSA has unique challenges as available data indicate that optimal benefit is derived from continued use throughout the patient's sleeping period while clinical trials continue to demonstrate suboptimal group adherence ranging from 3–5 h/night. Given this, substantial work remains to be done to determine the optimal combination of strategies to maximize adherence. All researches on increasing adherence has evaluated outcomes at 3 months or less, despite evidence that usage continues to wane over time long-term. Evaluation of strategies to maintain adherence long term is a critical research priority. Other fields to focus are strategies for identification of patient-factors that place them at risk for nonadherence prior to PAP use, and the development and validation of specific algorithms to utilize with telemonitoring to identify nonadherent patients early after initiation of PAP. Comparative effectiveness studies will be needed to develop a comprehensive adherence program that can be deployed into routine clinical care. Support (if any)