Abstract
BackgroundSleep apnea patients on CPAP therapy exhibit differences in how they adhere to the therapy. Previous studies have demonstrated the benefit of describing adherence in terms of discernible longitudinal patterns. However, these analyses have been done on a limited number of patients, and did not properly represent the temporal characteristics and heterogeneity of adherence.MethodsWe illustrate the potential of identifying patterns of adherence with a latent-class heteroskedastic hurdle trajectory approach using generalized additive modeling. The model represents the adherence trajectories on three aspects over time: the daily hurdle of using the therapy, the daily time spent on therapy, and the day-to-day variability. The combination of these three characteristics has not been studied before.ResultsApplying the proposed model to a dataset of 10,000 patients in their first three months of therapy resulted in nine adherence groups, among which 49% of patients exhibited a change in adherence over time. The identified group trajectories revealed a non-linear association between the change in the daily hurdle of using the therapy, and the average time on therapy. The largest difference between groups was observed in the patient motivation score. The adherence patterns were also associated with different levels of high residual AHI, and day-to-day variability in leakage.ConclusionThe inclusion of the hurdle model and the heteroskedastic model into the mixture model enabled the discovery of additional adherence patterns, and a more descriptive representation of patient behavior over time. Therapy adherence was mostly affected by a lack of attempts over time, suggesting that encouraging these patients to attempt therapy on a daily basis, irrespective of the number of hours used, could drive adherence. We believe the methodology is applicable to other domains of therapy or medication adherence.
Highlights
Sleep apnea patients on continuous positive airway pressure (CPAP) therapy exhibit differences in how they adhere to the therapy
In this work we explore the longitudinal therapy adherence patterns that obstructive sleep apnea (OSA) patients exhibit during their first three months of continuous positive airway pressure (CPAP) therapy
The model fits for different degrees of polynomials (P = 0, 1, 2), and the fixed effects model are reported in Table 1 in terms of the Akaike information criterion (AIC)
Summary
Sleep apnea patients on CPAP therapy exhibit differences in how they adhere to the therapy. The degree to which patients are successful in adhering to their treatment depends on the condition, dosing frequency, treatment duration, and many other factors [1]. Another aspect of interest is the change in adherence over time, of which an improved understanding can contribute to the early prediction of non-adherence and help in selecting the appropriate intervention. Identifying common patterns of adherence provides population-level insights on how patients typically use the therapy. It may guide new interventions for targeting the specific adherence behaviors, or help durable medical equipment providers with substantiating their reimbursement claims
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
