444 Enhancing PAP Compliance Efficacy with Early Closer Follow-ups (2–3 days vs others): A Retrospective Single-Centre Review

Abstract

Abstract Introduction PAP is an effective gold standard for OSA treatment; however, compliance remains an issue. Centre for Medicare defines compliance as PAP usage of ≥4hrs daily and ≥70% in a 30-day period. This study aimed at evaluating the effectiveness of early patient-centred follow-ups (2–3 days mandatory versus 4 weeks mandatory and/or as needed basis). Methods Retrospective data analysis of 100 consecutive patients (≥18 years) over a year in an interrupted time series with pre-test (Group1) and post-test (Group2) of 50 patients each. All patients included were symptomatic (ESS ≥10), CPAP naive, diagnosed with OSA, and diagnostic AHI ≥5. All received a post diagnostic sleep questionnaire assessing their overall quality of sleep with PAP therapy. Therapeutic AHI was collected from updated 90-day compliance report thru web enabled online RESMED AIRVIEW’s secure database. Initial follow-up for Group1 was in 4 weeks and/or earlier if patient initiated and for Group2 in 2–3 days following PAP set up. Additionally, non-compliant patients in Group2 received monthly follow-ups. Results Following findings were reported for Group1 - (Male=24, Female=26), mean age 65.79±13.21, and BMI 36.12±7.50; and Group2 - (Male=25, Female=25), mean age 62.8±12.32, and BMI 36.90±9.29. During diagnostic testing >50% patients in both groups rated their overall sleep to be worse than usual. Compliance for Group1 was significantly worst than Group2 (64% and 91%, respectively). Group1 had 8=AHI≥5, 29=AHI≤5 and had 13 lost to followup (11 behavioural in-adaptations, 2 financial constrains) soon after commencing CPAP. Group2 had 3 lost to financial constraints, 4=AHI≥5, and 43=AHI<5. Chi-square (5.4265) indicated p-value=.019, chi-square Yates-correction (4.502) calculated p-value=.033. Significant at p<.05, Chi-square test revealed dependant relationship between PAP unsatisfactory patient evaluation during diagnostic polysomnography to PAP non-compliance. Group1’s RR=3 and OR=4.45; Group2’s RR=0.33 and OR=0.22, indicated higher probability of non-compliance in Group1. Conclusion Provider-patient contact within 2–3 days versus any other intervals (4 weeks mandatory and/or as needed in this case), soon after commencing PAP therapy not only increases compliance efficacy but also reduces patient dropouts and anxiety with PAP therapy. Considerable fraction of patients are uncomfortable using CPAP; therefore, closer follow-ups versus 4 weeks is warranted to maintain CPAP adherence. Support (if any):