0694 Positive Airway Pressure Use In The Context Of Total Sleep Time

Abstract

Abstract Introduction Positive airway pressure (PAP) adherence definitions are independent of total sleep time (TST). When PAP efficacy is examined by biophysiologic outcomes in adults with obstructive sleep apnea (OSA), sensitivity and specificity of the measurement of PAP adherence/non-adherence is important. Methods A post-hoc analysis of experimental data: 1) investigated agreement among concurrently-measured objective PAP use, objective and subjective TST; 2) assessed untreated TST among adherers and non-adherers defined by CMS PAP adherence criterion and separately by proportion of TST on PAP criteria (≥65%, ≥75%, ≥85%). Objective TST was measured with wrist actigraphy and concurrent sleep diary on the first five days of PAP use. Objective five day PAP use (hours/night) was abstracted from full record. Analyses included descriptive and exploratory correlations. Results PAP-naïve adults (n=36; 76% male, 84% white) were middle-aged (51±10 years), with severe OSA (median AHI 31.1 events/hr), mean PAP use (371.5±85.4 min), mean objective and subjective TST (417.5±50.6 min, 439.6±58.1 min, respectively) from a single sleep center. Objective TST was correlated with concurrent objective PAP use (r=0.46) and with subjective TST (r=0.78). Eight percent (39mins) of objective TST was untreated among CMS-defined adherers, and 54.1% (216.8mins) of TST was untreated among CMS-defined non-adherers. When TST-on-treatment criteria were imposed (≥65%, ≥75%, and ≥85%, respectively), the percentage of untreated TST decreased among adherers, 5.2% (23 min), 4.3% (19 min), 0% (0 min) and among non-adherers, 42.8% (168 min), 41.2% (162 min), and 28.7% (118 min). From CMS to ≥85% of TST-on-treatment criteria, categorization as an adherer decreased from 89% (n=34) to 58% (n=22); non-adherer categorization increased from 5% (n=2) to 37% (n=14). Conclusion In the context of understanding biophysiological responses to PAP treatment, more sensitive and specific criteria for adherence and non-adherence is necessary. PAP use based on untreated TST is an opportunity to address this gap. Support The parent clinical trial was supported by NIH/NINR (R00NR011173; Sawyer PI)