Positive Airway Pressure Usage Research Articles

Effect of telemonitoring and as-needed patient support on positive airway pressure therapy adherence.

Obstructive sleep apnea (OSA) affects patient health and public welfare. Positive airway pressure (PAP) therapy is the preferred treatment of OSA, but therapy adherence rates remain suboptimal. Current literature demonstrates telemonitoring interventions to support improved PAP therapy adherence. To evaluate the effect of interval telemonitoring of PAP therapy data at 2 and 4 weeks after treatment initiation in patients with moderate-to-severe obstructive sleep apnea with as-needed patient support and troubleshooting by telephone consultation. Ninety-nine participants were enrolled in this study, 50 in the control group and 49 in the intervention group. Data were analyzed using descriptive and inferential statistics using SPSS 28.0 software. The primary outcome of interest was 90-day PAP adherence. Mean PAP adherence scores diverged at 90 days after PAP initiation, with the intervention group having a significantly higher mean score (M = 49.24, SD = 38.18) relative to the control group (M = 36.38, SD = 37.69). Likewise, continued PAP usage at 90 days after therapy initiation diverged between participant groups, with the intervention group having a significantly higher mean score (M = 89.80, SD = 30.58) relative to the control group (M = 72.00, SD = 45.36). The intervention resulted in significantly higher mean PAP adherence and a greater percentage of participants demonstrating continued PAP usage at 90 days after therapy initiation but did not result in a statistically significant increase in what is considered and defined as "good PAP adherence" (adherence of ≥70%). Data-triggered telemonitoring protocols offer supplementary support to patients in need and improve PAP adherence.

Remote monitoring system to support positive airway pressure therapy in patients with obstructive sleep apnea: a multi-center randomized controlled trial.

To develop and evaluate an intervention tailored to patients' needs to increase the rate of positive airway pressure (PAP) adherence in patients afflicted with obstructive sleep apnea (OSA), who undergo PAP therapy. A multi-center, 3 parallel-arm, randomized, controlled trial was conducted. Participants with OSA who undergo a PAP therapy were randomized to one of three groups: control arm (usual care), educational booklet arm, and mobile-based application arm. PAP usage, the percentage of days using the device for more than 4h, change in knowledge, risk perception, outcome expectancy, self-efficacy, and ESS were assessed before and one month after interventions in the three groups. Also, the application usage data were analyzed. The result showed the change in average PAP usage, knowledge, risk perception, and self-efficacy in the application group was significantly higher than the control and booklet groups. Also, the change in use for more than 4h in the application group was significantly higher than the control group. Comparing the actual and patients' self-report PAP use indicated patients' self-report about the use of the device is about 50min (0.8h) more than the actual amount of use. The study results indicated that the improvement of primary and secondary outcomes in adherence to PAP was significantly higher in the application group than in other study groups. Given the increasingly penetrating influence of smartphone-based technologies, it seems that mobile-based applications could potentially be adopted in the population of patients with OSA. IRCT2017092236314N1; https://en.irct.ir/trial/27185.

Behavioral KSA Intervention Class to Boost Positive Airway Pressure Adherence Among Active Duty Military Personnel With Obstructive Sleep Apnea.

Obstructive sleep apnea (OSA) is a treatable cause of daytime sleepiness and associated medical problems that can negatively impact soldier readiness and performance. This study examined adherence to positive airway pressure (PAP) by soldiers who were newly diagnosed with OSA and prescribed PAP therapy and participated in a Knowledge, Skills, and Attitudes (KSA) behavioral intervention class. The KSA was a one-time, interactive 90-minute class attended by up to 10 patients per class. PAP adherence was examined using Medicare standard at 30-, 60-, 90-, and 180 days post class. The analytic sample comprised 379 active duty patients (93% men; mean age 40.21 ± 8.06) categorized into 3 groups: KSA (n = 235), did not show (DNS; n = 61), and mandatory education class (MEC; n = 83). The MEC group comprised patients from an education class in a previous year. Baseline scores on the apnea hypopnea index, body mass index, sleepiness, insomnia severity, and age were non-significant among the 3 groups. At 30 days, significantly more patients in KSA (48%) and MEC (51%) were adherent than the DNS group (16%). At 60 days, the adherence rates for the KSA, DNS, and MEC were significantly different at 39%, 22%, and 27%, respectively. At 90- and 180 days, the adherence rates among the KSA, DNS, and MEC groups did not differ significantly at 34%, 17%, and 26% (90 days) and 34%, 27%, and 25% (180 days), respectively. Consistently, more patients in KSA were adherent than those in DNS and MEC, except at 30 days. Additionally, adherence rates for KSA intervention declined more gradually over the 6 month period. The mean PAP usage on nights used was 4.6 hours that computed to a 34% non-use rate based on an optimal 7-hour/night sleep time. KSA could be a behavioral intervention that enhances PAP adherence with a booster session implemented at the 90 days mark.

Association between a Recalled Positive Airway Pressure (PAP) Device and Incident Cancer: A Population-Based Study.

The real-world consequences of a Philips/Respironics recall for positive airway pressure (PAP) devices distributed between 2009 and 2021 are unknown. We conducted a retrospective population-based study using health administrative databases (Ontario, Canada) on all new adult PAP users identified through the provincial funding system, free of cancer at baseline, who initiated (claimed) PAP treatment between 2012 and 2018. Everyone was followed from the PAP claim date to the earliest of incident cancer diagnosis, death, or the end of the follow-up (March 2022). We used inverse probability of treatment weighting to balance baseline characteristics between individuals on recalled devices and those on devices from other manufacturers. Weighted hazard ratios of incident cancer were compared between groups. Of 231 692 individuals identified, 58 204 (25.1%) claimed recalled devices, and 173 488 (74.9%) from other manufacturers. A meaningful baseline difference between groups (standardised difference≥0.10) was noted only by location-relevant covariates; other variables were mostly equally distributed (standardised differences≤0.06). Over a median follow-up of 6.3 years (IQR: 4.9-8.0), 11 166 (4.8%) developed cancer: unadjusted rates per 10 000 Person-Year (95 CI%) of 78.8 (76.0-81.7) in the recall group versus74.0 (72.4-75.6) in others (p=0.0034). Propensity score weighting achieved excellent balance in baseline characteristics between groups (standardised differences≤0.07). On a weighted sample, there was no statistical difference in the hazard of incident cancer between groups: cause-specific hazard ratio (recalled versus others) of 0.97, 95% CI: 0.89-1.06. In our real-world population study, compared to other manufacturers and adjusting for confounders, recalled devices do not appear to be independently associated with developing cancer.

Air pollution, weather and positive airway pressure treatment adherence in adults with sleep apnea: a retrospective community-based repeated-measures longitudinal study.

We assessed the relation between air pollution, weather, and adherence to positive airway pressure (PAP) therapy in a retrospective community-based repeated-measures study of adults with obstructive sleep apnea who purchased PAP devices from a registered provider between 2013 and 2017 (Ottawa, Ontario, Canada) and had at least one day of data. Daily PAP-derived data, air pollution, and weather databases were linked using postal code. The exposures were mean nocturnal (8:00 p.m. to 8:00 a.m.) (i) residential concentrations of nitrogen dioxide (NO2 ), fine particulate matter <=2.5 μm (PM2.5 ), ozone (O3 ), and Air Quality Health Index (AQHI), and (ii) temperature, relative humidity, and barometric pressure. Covariates in the main model were demographics, season, exposure year, and PAP therapy mode. We analysed 8148 adults (median age of 54 years and 61% men) and 2,071,588 days of data. Based on daily data, the median (interquartile range) daily PAP usage was 416 (323-487) min. Using mixed-effect regression analyses to incorporate daily data and clustering by individuals, we found a statistically significant decrease in adherence for increased levels of NO2 , PM2.5 , and AQHI. The largest effect was for NO2 : a decrease in daily PAP use while comparing the highest versus lowest quartiles (Qs) was 3.4 (95% confidence interval [CI] 2.8-3.9) min. Decreased PAP adherence was also associated with increased temperature (Q4 versus Q1: 2.6 [95% CI: 1.5-3.7] min) and decreased barometric pressure (Q1 versus Q4: 2.0 [95% CI 1.5-2.5] min). We observed modest but statistically significant acute effects of air pollution and weather on daily PAP adherence.

Positive Airway Pressure Therapy Compliance in Patients With Comorbid Insomnia and Sleep Apnea.

This study aimed to compare positive airway pressure (PAP) therapy compliance between patients with comorbid insomnia and sleep apnea (COMISA) and those with obstructive sleep apnea (OSA) alone. It also assessed the influence of insomnia clinic visits on PAP compliance. Patients diagnosed with OSA and initiated on PAP therapy between January 2012 and December 2021 were included. The COMISA group (n=43) comprised patients with insomnia, while the control group (n=86) consisted of OSA patients without insomnia, matched 1:2 based on age and sex. COMISA patients were further categorized into group A (n=20), with at least two insomnia clinic visits, and group B (n=23) with one or no visits. PAP compliance in each group was evaluated at 3 and 9 months. No significant differences were observed in PAP compliance between the COMISA patients and OSA patients without insomnia. Within the COMISA group, the impact of insomnia clinic visits on PAP compliance was not significant. No significant difference was observed in daily PAP usage between the two groups at 3 months (265.5±145.9 minutes in group A vs. 236.3±152.3 minutes in group B, P=0.760) or 9 months (213.4±155.3 minutes in group A vs. 166.3±158.3 minutes in group B, P=0.538). The percentages of PAP users and nights with PAP use exceeding 4 hours also showed no significant differences at either time point. This study demonstrated no significant disparity in PAP compliance between the COMISA and OSA groups at either 3 or 9 months. Furthermore, insomnia clinic visits did not significantly impact PAP compliance in COMISA patients during 3- and 9-month intervals.

Positive airway pressure therapy adherence and outcomes in obstructive sleep apnea: An exploratory longitudinal retrospective randomized chart review.

Positive airway pressure (PAP) therapy is prescribed to patients with obstructive sleep apnea (OSA). A commonly used definition for PAP therapy adherence is based upon the minimum requirements to receive Medicare coverage in the US, defined as PAP usage of four or more hours per night on 70 percent of nights for at least 30 consecutive days. However, little evidence exists to support this definition for PAP therapy adherence. Therefore, the present study sought to determine the efficacy of the present definition of PAP therapy adherence on longitudinal outcomes in patients with OSA, using objectively measured PAP device usage time. An exploratory longitudinal, retrospective, randomized chart review was done to assess clinical outcomes between patients with OSA who were defined as PAP therapy adherent (n=50) and non-adherent (n=50) during an eight-year observation period. No significant differences were shown between groups for mortality, hospitalizations, or development of co-morbidities during the observation period. However, logistic regression showed significantly higher odds of adherence in male patients compared to female patients (OR=8.519; 95%CI=1.301-55.756; p=0.025) and significantly lower odds of adherence in patients with higher normal (OR=0.039; 95%CI=0.005-0.392; p=0.003), mild excessive (OR=0.039; 95%CI=0.003-0.517; p=0.014), and severe excessive (OR=0.088; 95%CI=0.012-0.635; p=0.016) daytime sleepiness compared to patients with lower normal daytime sleepiness. An increasing number of hospitalizations also corresponded with a significant decrease in odds of being adherent (OR=0.741; 95%CI=0.551-0.995; p=0.046). The present study supports a steadily growing body of literature calling for more consideration and evidence to support a definition of PAP therapy adherence that is clinically meaningful.

Age matters: association between age and depression severity at the time of OSA diagnosis and PAP adherence in adult patients.

Numerous studies have shown an association and symptom overlaps between obstructive sleep apnea (OSA) and depression. However, data are limited on the association between age, sex, the severity of depression at the time of OSA diagnosis, and its impact on positive airway pressure (PAP) adherence. The Patient Health Questionnaire (PHQ-9) is a validated depression screening and severity scoring tool recommended by the Diagnostic and Statistical Manual of Mental Disorders (fifth edition). In this retrospective observational study, we evaluate the interrelationship between age at OSA diagnosis, depression severity, and PAP adherence. Patients with new OSA diagnosis, seen at the University of California San Francisco-Fresno Sleep Center between February and October of 2022, were evaluated. PHQ-9 scores for depression severity uses a 1 to 5 scale (1 = none, 2 = mild, 3 = moderate, 4 moderately severe, 5 = severe). The PHQ-9 was administered at the time of OSA diagnosis and follow-up. Average daily PAP usage hours were obtained from PAP devices between 1 to 3 months after therapy initiation. IBM SPSS version 29.0.0 was used to calculate descriptive statistics, Pearson correlation, and Mann-Whitney test. Seventy-seven patients fit the inclusion criteria, of which 28 were women (36.4%). The average baseline apnea-hypopnea index was 34.5 (standard deviation 31.8), with a PHQ-9 mean of 8.3 with standard deviation ± 5.9. A Mann-Whitney comparison between the group with normal PHQ-9 scores and the group with PHQ-9 scores consistent with depression (score of 5 or greater) showed no statistically significant differences in apnea-hypopnea index (P = .470) or average night hour use (P = .195). There was a statistically significant difference in age between both groups (P = .031). Spearman correlation confirmed a negative, statistically significant correlation between PHQ-9 scores and age in patients with OSA. This study showed that PHQ-9 scores at the time of OSA diagnosis are moderately correlated with younger age, with those patients younger than 50 years old having more moderate to severe depression scores than older patients. We did not find a correlation between age and PAP adherence or between PHQ-9 scores and PAP adherence. Our findings can help identify high-risk depression patients early in the diagnosis of OSA and bring awareness that the young adult population can be particularly vulnerable. Niraula R, Singh A, DelRosso LM, Meghpara S, Keenan L. Age matters: association between age and depression severity at the time of OSA diagnosis and PAP adherence in adult patients. J Clin Sleep Med. 2024;20(6):859-862.

P002 Positive airway pressure adherence in children with sleep apnea may be similar to adults

Abstract Introduction Most pediatric patients with obstructive sleep apnea (OSA) are known to be treated with adenotonsillectomy (AT). However, in some of them, positive airway pressure (PAP) can be used for underlying diseases or in case of AT failure. Thus, PAP adherence and compliance were compared in pediatric OSA to adult OSA. Methods A retrospective study was conducted on 17 children and 167 adults who had performed polysomnography (PSG) and were prescribed PAP and followed up for more than 3 months from July 2018 to January 2023. Adherence was defined as the percentage of patients continuing to use PAP after prescription and compliance was defined as an average of more than 4 hours per night usage of 70% of the monitoring days. Results There were 11 males (64.7%) in pediatric and 141 males (84.4%) in adult patients. The mean age was 8.0 years (6.50-12.50) in pediatric and 50.0 years (41.00-58.00) in adult patients. The mean apnea hypopnea index (AHI) (37.0 vs 50.7) and Lowest O2 saturation (79.4% vs 75.5%) did not show any differences in the 2 groups. Longest apnea showed considerable differences (25.9 sec vs 50.8 sec) (p=0.000). After 18 months of PAP usage, AHI dropped from 37.0 to 5.1 vs 50.7 to 2.6, adherence decreased from 94.1% to 41.2% vs 90.4% to 38.9% (p=0.944), compliance reduced from 64.7% to 28.9% vs 67.0% vs 29.3% (p=0.268) in pediatric and adults groups. Conclusions There were no significant differences in adherence and compliance with PAP in children compared to adults.

Positive airway pressure treatment affects respiratory symptoms and gastro-oesophageal reflux: the Icelandic Sleep Apnea Cohort Study.

To study the effect of positive airway pressure (PAP) treatment on nocturnal gastro-oesophageal reflux (nGOR) and respiratory symptoms among clinical obstructive sleep apnoea (OSA) patients. 822 patients newly diagnosed with OSA referred for PAP treatment were recruited. 732 patients had a 2-year follow-up visit with continuous PAP compliance data (366 full PAP users, 366 partial/non-PAP users). They answered questionnaires, including reporting of nGOR, sleep and respiratory symptoms and general health. Patients with nGOR symptoms once a week or more were defined as "with nGOR". Those without nGOR symptoms and nGOR medication were defined as "no nGOR". Others were defined as "possible nGOR". At 2-year follow-up, PAP treatment among full users resulted in decreased nGOR (adjusted OR 0.58, 95% CI 0.40-0.86) and wheezing (adjusted OR 0.56, 95% CI 0.35-0.88) compared with partial/non-PAP users. Decreased nGOR, among both full and partial/non-users of PAP treatment, was associated with a decrease in productive morning cough (adjusted OR 4.70, 95% CI 2.22-9.99) and a decrease in chronic bronchitis (adjusted OR 3.86, 95% CI 1.74-8.58), but not decreased wheezing (adjusted OR 0.90, 95% CI 0.39-2.08). A mediation analysis found that PAP treatment directly led to a decrease in wheezing, not mediated through nGOR. Conversely, PAP treatment decreased productive cough mediated through a decrease in nGOR. In an unselected group of OSA patients, PAP treatment for 2 years was associated with a decrease in nGOR and respiratory symptoms. The PAP treatment itself was associated with less wheezing. A decrease in nGOR through PAP treatment was associated with a decrease in productive cough.

Influence of excessive daytime sleepiness on the treatment adherence of obstructive sleep apnea

ObjectivesTo compare positive airway pressure (PAP) adherence between patients with or without excessive daytime sleepiness (EDS) in mild, moderate and severe obstructive sleep apnea (OSA). MethodsPatients ≥18 years diagnosed with OSA in 2018 and 2019, without previous history of PAP usage and with adherence registration in the first medical consultation after treatment initiation, were included. EDS was defined as a score of ≥10 on the Epworth Scale. Patients were divided into two groups according to the adherence to PAP: “Adherent” if using the device for ≥4 h for ≥70% of the nights and “Nonadherent” otherwise. Simple and multiple logistic regression models for adherence were determined. Results321 patients were included, most male (64.2%), with mean age 56.56 years. Most patients had severe OSA (n = 159; 49.5%), and median AHI was 29.3/h [16.8; 47.5]. Being older or having a severe OSA resulted in an increased adherence (OR = 1.020, CI95% = [1.002; 1.039] and OR = 2.299, CI95% = [1.273; 4.191], respectively). In patients without EDS a statistically significant difference was found in adherence between those with severe OSA and both mild and moderate OSA categories (OR = 0.285, p = 0.023 and OR = 0.387, p = 0.026, respectively), with patients with severe OSA being adherent. There was no statistical difference in adherence between patients with or without EDS (OR 1.083; p = 0.876), nor in the different degrees of severity in those with EDS. ConclusionIn our study there were no differences in PAP therapy adherence between patients with or without excessive daytime sleepiness. Older age and higher OSA severity resulted in higher adherence rates.

645-P: Experiences of Managing Comorbid Obstructive Sleep Apnea and Type 2 Diabetes among Veterans

Obstructive sleep apnea (OSA) is highly prevalent in patients with type 2 diabetes (T2DM), more so in veterans compared to non-veterans. Positive airway pressure (PAP) is the recommended first-line treatment for OSA. However, adherence to both PAP and to diabetes management regimens can be challenging to older adults. This study describes older veterans’ experiences managing comorbid OSA and T2DM, and the types of support they receive from family and friends. Methods: We conducted a postal survey of 900 randomly selected veterans (aged ≥50 years with medical diagnoses of OSA and T2DM) from one VA healthcare system. Questions included the Diabetes Patient Behavior Checklist and perceived benefits of and assistance with PAP use. Results: Of the 145 respondents (97% men, 51% White, 21% Black, mean age 72 years), 43% received help for diabetes from family or a friend, including preparing healthy food (91%), providing encouragement for diabetes self-care (89%), and eating at the same time (89%). Almost two thirds of the respondents were current PAP users. Among the respondents, 27% received help using PAP from a household member, including putting on the mask (68%), filling the water reservoir (59%), and cleaning the device (59%). Current PAP users had significantly lower levels of hemoglobin A1c than nonusers (6.7 ± 1.1 vs. 7.3± 1.6 %, respectively, p=0.008). Current PAP users also reported significantly higher perceived benefits of PAP use on improving sleep quality, sleep apnea, diabetes, and general health than nonusers. Married or non-White respondents thought it would be more helpful for a family member or friend to receive education on treatment of both OSA and T2DM. Conclusion: Future studies should investigate feasible strategies for addressing adherence to PAP use as part of diabetes self-management to improve glycemic control and overall health outcomes among patients with T2DM and comorbid OSA. Family support and social/demographic factors should be considered. Disclosure Y.Song: None. S.E.Choi: None. A.Papazyan: None. P.M.Macey: None. C.Alessi: None. C.H.Fung: None. J.Martin: None. Funding National Institutes of Health (K23AG055668); University of California, Los Angeles Clinical and Translational Science Institute School of Nursing

Pilot study of positive airway pressure usage, patient journey and program engagement for users of a digital obstructive sleep apnea program.

This single-arm, decentralized pilot study assessed patient journey, positive airway pressure (PAP) usage and program satisfaction for users of an entirely virtual telemedicine program for obstructive sleep apnea (OSA) diagnosis and management. This analysis focuses specifically on the subset of participants in the program who were diagnosed with OSA and prescribed PAP therapy. The Verily Clinical Studies Platform was used for virtual screening, consent, and enrolling eligible patients from North Carolina and Texas. After completing the virtual OSA diagnosis process, participants diagnosed with OSA and prescribed PAP therapy downloaded the program's mobile app. The app featured tools such as educational content, live coaching support, and motivational enhancement. Of the patients included in this analysis (N = 105), the majority were female (58%), and white (90%). The mean time from first televisit to PAP initiation was 29.2 (SD 12.8) days and f 68 out of the 105 patients (65%) reached 90-day adherence. On average, patients used their PAP device for 4.4 h per day, and 5.4 h on days used. Engagement with the app was associated with higher rates of PAP adherence. Adherent individuals used the mobile app 52 out of the 90 days on average, compared to non-adherent individuals who used the app on 35 out of the 90 days on average (p = 0.0003). All of the 105 patients in this program diagnosed with OSA and prescribed PAP therapy were able to efficiently complete the entire OSA diagnostic pathway. The majority of these individuals also were able to adhere to their prescribed PAP therapy and had clinically meaningful PAP usage rates over the 90 days of therapy. Future studies might further evaluate the impact of this type of end-to-end virtual program on longer-term adherence and clinical outcomes over time. https://clinicaltrials.gov/ct2/show/NCT04599803?term=NCT04599803&draw=2&rank=1, identifier NCT04599803.

Respiratory infection risk in positive airway pressure therapy users: a retrospective cohort study.

Concerns regarding the risk of positive airway pressure (PAP)-associated respiratory infection (RI) have shaped consumer views toward PAP device use and maintenance. However, data regarding temporal associations between PAP use and risk for RIs are limited. The purpose of the present study was to examine longitudinal associations between PAP use and risk of clinically significant RIs in a cohort of patients with obstructive sleep apnea. The frequency of clinically reported respiratory RIs pre- and post-PAP use were compared in a sample of 482 adult patients with obstructive sleep apnea who underwent PAP titration at a large academic sleep center between 2011 and 2014. RIs were identified by clinical record review beginning two years before and ending two years after the participants' PAP titration. Presence of longitudinal standard PAP data download reports identified PAP users from nonusers. PAP adherence was defined as at least 4 hours of use per day, five days per week for at least 70% of days. Poisson regression models, adjusted for age, sex, body mass index, and the number of pre-PAP use RIs were utilized to examine associations between PAP use and subsequent RIs. Poisson regression models adjusted for age, sex, body mass index, and the number of pre-PAP use RIs did not show associations between PAP therapy use and rate of post-PAP use RIs (rate ratio = 1.27, 95% confidence interval: 0.86-1.86). A sensitivity analysis that included only PAP users with difference in PAP adherence showed similar results (rate ratio = 0.65, 95% confidence interval: 0.32-1.30). Among adults with obstructive sleep apnea, we did not find evidence for association between PAP use/adherence and increased RI frequency. These data offer new information that could assuage patients with obstructive sleep apnea who are considering PAP deferral based on RI concerns. Gavidia R, Shieu MM, Dunietz GL, Braley TJ. Respiratory infection risk in positive airway pressure therapy users: a retrospective cohort study. J Clin Sleep Med. 2023;19(10):1769-1773.

0434 Long-Term Positive Airway Pressure Usage Disparities in Black or Hispanic of any Race Adults with OSA

Abstract Introduction Black or African American and Hispanic of any race (B/H) adults are disproportionately affected by obstructive sleep apnea (OSA). Positive Airway Pressure (PAP) treatment may reduce disparities, but short-term PAP outcomes are worse among under-represented minority (URM) adults compared to other, mainly White, adults. No studies have examined if adherence disparities persist/worsen long-term. We evaluated disparities in PAP usage between B/H adults and other race/ethnicities. Methods We defined a clinical cohort of adults with moderate-severe OSA (apnea-hypopnea index [AHI]≥15 events/h) that underwent diagnostic sleep studies and initiated PAP between 01/2015-03/2018. Logistic regression was used to examine differences in the likelihood of still using PAP or meeting adherence threshold of ≥4 hours/night at 18-24 months. We performed mixed model for repeated measures to examine differences in h/night of PAP use over two years. Analyses were controlled for age, sex, BMI, AHI, and 3-month PAP usage to understand whether disparities emerged independent of short-term differences. Results Analyses included 1,518 individuals (694 [45.7%] B/H) with PAP usage at 3 months, who were middle-aged (53.4±14.1 years-old), majority men (64.4%), obese (38.2±9.8 kg/m2) and had severe OSA (46.6±30.2 events/h). B/H adults had 70% higher odds (OR [95% CI] = 1.70 [1.33-2.17]) of no longer using PAP 18-24 months after initiation. B/H adults using PAP had ~2 hours/night less usage than other race/ethnicities at 18-24 months (2.72 [2.49-2.97] vs. 4.52 [4.31-4.73] hours/night; p&amp;lt; 0.0001). This difference was attenuated but remained significant after accounting for 3-month usage (mean [95% CI] difference = -0.64 [-0.92, -0.37] hours/night). B/H adults using PAP were also 3-times more likely to be non-adherent at 18-24 months (OR [95% CI] = 3.00 [2.28-2.95]), and remained 2-times more likely to be non-adherent controlling for 3-month usage (2.14 [1.56-2.92]). Conclusion At 18-24 months, Black or Hispanic of any race adults with moderate-severe OSA were less likely to use PAP, had less usage when still using PAP, and were less likely to achieve adherence thresholds. Long-term PAP disparities exist, even after accounting for short-term differences. Promoting longer-term PAP adherence for URM is a priority to reduce these disparities and address healthcare inequities. Support (if any) AHA (20CDA35310360), NIH P01 HL094307, AHRQ K12HS026372

0815 Utilization of Telemedicine visits in a Pediatric Sleep Center and the Effect on PAP Adherence Rates

Abstract Introduction Although positive airway pressure (PAP) is an effective treatment for OSA, adherence is often suboptimal. Consistent follow up is needed to address barriers to adherence; however, in-person clinic attendance in our center has been low and was further reduced during the COVID-19 pandemic. Suboptimal adherence may result in cessation of reimbursement by insurance, leaving OSA untreated. Untreated OSA in children can lead to behavior and learning problems, impaired growth and cardiovascular complications. Due to the decrease in show rates, in-home telemedicine visits were offered in lieu of in-person visits. Methods A retrospective chart review was performed for children with OSA seen in the pediatric sleep clinic from March 2020 and October 2022. Subjects were excluded from analysis if they did not transition to telemedicine. Telemedicine visits were conducted in the same manner as in-person visits. PAP usage after telemedicine was compared to in-person visits. Adherence was reported as percent of total usage and percent of usage greater than four hours (U&amp;gt;4h) per night. Results Three hundred nineteen charts were reviewed of whom the majority were male (69.9%). The median age (interquartile range) at PAP initiation was 12 years (7-15). Seventy eight subjects were included in the analysis. Mean U&amp;gt;4h and total usage decreased when subjects transitioned from in-person to telemedicine visits (4.18% ± 26.7, p=0.17 (3.08% ± 22.5, p=0.23), respectively. These differences were not significant. 36 subjects (46%) had &amp;lt; ± 5% change in total adherence, 23 (29%) had &amp;gt; 5% increase in total adherence, and 19 (24%) had &amp;gt; 5% decrease. When comparing change in U&amp;gt;4h, 29 (37%) subjects had &amp;lt; ± 5% change in adherence, 22 (28%) had &amp;gt; 5% decrease, and 27 (35%) had &amp;gt; 5% increase in adherence. Conclusion There were no statistically significant differences in adherence rates between telemedicine and in-person visits. Adherence improved in some children on transition from in-person to telemedicine visits. Utilization of in-home telemedicine visits may be a useful alternative for some children treated with PAP. Further studies are needed to determine which specific patient populations may benefit most from in-home telemedicine visits. Support (if any)

0429 ASSOCIATION BETWEEN HEALTHCARE COSTS AND CONTINUOUS POSITIVE AIRWAY PRESSURE ADHERENCE FOR TREATMENT OF OBSTRUCTIVE SLEEP APNEA

Abstract Introduction The impact of positive airway pressure (PAP) therapy on healthcare cost among patients with obstructive sleep apnea (OSA) requires further exploration. This study evaluated the associations between PAP adherence and cost in a large integrated healthcare system. Methods The study included adult patients with OSA (apnea-hypopnea index (AHI) ≥5) with available PAP therapy data between 1/1/2015 to 8/31/2019 from Kaiser Permanente Southern California. We followed the identified patients from the date of highest AHI before PAP use (index) up to 2 years. Each patient had PAP usage and cost organized into 6-month intervals, and mean hours/night and cost was calculated for each interval. Patients were stratified into the following adherence groups: (a) high adherence (≥4 hours/night consistently across all intervals); (b) moderate adherence (2–3.9 hours/night or ≥4 hours/night in some but not all intervals); (c) low adherence (&amp;lt; 2 hours/night). Healthcare costs (2020 US dollars) were derived by assigning costs from federal fee schedules to healthcare utilization extracted from electronic health records. The 6-month mean healthcare costs associated with PAP adherence were estimated using generalized linear models adjusting for patient demographics, comorbidities, Medicaid coverage, prior healthcare cost, and AHI. Stratified analyses based on age (&amp;lt; 65, ≥65 years) and AHI (&amp;lt; 15, ≥15) were conducted. Results A total of 25,700 patients (63.3% male; 41.6% with AHI ≥30) were included in the study. Among those, 53.2% (n=13,684) categorized as having low PAP adherence, 24.2% (n=6221) as moderate adherence, and 22.5% (n=5795) as high adherence. High adherence was associated with the lowest average multivariable adjusted 6-month healthcare cost ($3,586, 95% CI: $3,428, $3,745) compared with moderate ($4,035, 95% CI: $3,859, $4,211) and low ($4,232, 95% CI $4,110, $4,355) adherence. The cost differences between “high vs low” and “moderate vs low” adherence were $646 (p&amp;lt; 0.001) and $197 (p=0.050), respectively. The cost differences between “high vs low” adherence were $999 (p&amp;lt; 0.001) for those with ≥65 years and $657 (p&amp;lt; 0.001) for those with AHI ≥15. Conclusion Better PAP adherence was associated with significantly lower healthcare costs in patients with OSA although further understanding of the relationship is needed. Support (if any) KPSC Regional Research Committee Grant: KP-RRC-20210506.

0633 Age matters: Association between age and depression severity at the time of OSA diagnosis, and PAP adherence in adult patients

Abstract Introduction Numerous studies have shown association and symptom overlaps between Obstructive Sleep Apnea (OSA) and depression. However, data is limited on association between age, severity of depression at time of OSA diagnosis, and its impact on PAP adherence. Patient Health Questionnaire-9 (PHQ-9) is a validated depression screening and severity scoring tool recommended by DSM-V. In this retrospective observational study, we will evaluate the interrelationship between age at OSA diagnosis, depression severity and positive airway pressure (PAP) adherence. Methods Patients were seen at the University of California, San Francisco Fresno sleep center. PHQ-9 scores for depression severity uses a 1-5 scale (1 = none, 2 = mild, 3 = moderate, 4 moderately severe, 5 = severe). PHQ-9 was administered at diagnosis of OSA and follow up, and average daily PAP usage was obtained from PAP devices after 1 month of therapy initiation. IBM SPSS version 29.0.0 was used to calculate descriptive statistics, Pearson correlation and Mann Whitney test. Results Twenty-six participants were included with mean age 53.04 years and standard deviation (SD) 17.97. PHQ-9 scores ranged 4-27 with mean 10.6, SD 5.9, 40% with mild and 66.3% with moderate to severe scores. 53.8% were 50 years or older (“older”) while 46.2% were 49 years or younger (“younger”). Pearson correlation between average CPAP use and PHQ-9 scores was 0.181. Age did not affect PAP adherence (Pearson correlation -0.046). Moderate correlation was noted between age and PHQ-9 scores (-0.4390) with younger patients showing more severe depression scores. Comparison between “older” and “younger” patients showed significant difference in PHQ-9 scores (p=0.020). Conclusion This study showed that PHQ-9 scores at the time of OSA diagnosis are moderately correlated with younger age, with those patients younger than 50 years old having more moderate to severe PHQ-9 scores than patients 50 years or older. We did not find correlation between age and PAP adherence or between PHQ-9 scores and PAP adherence. Our findings can help identify depression early on in the diagnosis of obstructive sleep apnea and bring awareness that the young adult population can be particularly vulnerable. Support (if any)

0463 Deep Learning Classification of Future PAP Adherence based on CMS and other Adherence Criteria

Abstract Introduction Improving positive airway pressure (PAP) adherence is crucial to sleep apnea therapy success. Although behavioral interventions may be deployed to increase PAP adherence, operationalization remains an ongoing clinical challenge. Treatment outcomes may be optimized by forecasting PAP use to identify patients at risk for non-adherence enabling early intervention. We build upon our previous work by leveraging a larger dataset, additional metadata, and new Deep Learning approaches to forecast future PAP adherence. Methods We collected a cohort of N=21,397 subjects with daily PAP usage recorded during 2015-2021. We defined the input to models as the number of minutes the PAP machine was used during each day for the first 30-days. The ground truth was defined as the PAP adherence of the patients at the 3-month, 6- month, and 1-year endpoints. Adherence was calculated based on a 30-day window as ≥4-hours of usage for ≥70% of nights. We evaluated a Deep Neural Network (DNN) model with 10-fold cross- validation to forecast future adherence by leveraging previous daily usage information. Results were compared to a naive method which assumes adherence at each time point equals adherence during the first 30-days. Results The DNN models predicted adherence with a sensitivity of 90%, 81%, 77% and a specificity of 90%, 81%, 77%, for 3-month, 6-month, and 1-year endpoints, with ROC-AUC values of 0.97, 0.89, and 0.84 respectively. The models converged to ROC-AUC performance &amp;gt;0.90 for the first 90-days within the first 7 to 14-days of PAP use. Conclusion DNN models demonstrated strong predictive performance for PAP adherence, as defined by the CMS adherence criteria, measured by sensitivity, specificity, and overall ROC-AUC results at clinically relevant 90-day, 6-month, and 1-year timepoints. AI approaches show promise as early predictors of the likelihood to meet key therapy utilization thresholds within the first 1-2 weeks of therapy, enabling early PAP intervention or transition to alternative therapies. Support (if any) AASM Foundation SRA205-SR-19

Relationship between Self-reported Sleepiness and Positive Airway Pressure Treatment Adherence in Obstructive Sleep Apnea.

Rationale: Positive airway pressure (PAP) is the first-choice treatment for obstructive sleep apnea (OSA). However, its real-world effectiveness is often questioned because of usage issues. The relationship between patient sleepiness and PAP usage has been assessed in relatively small and selected populations within the research context. Objectives: To assess the impact of patient-reported sleep outcomes, particularly self-reported sleepiness and its change during therapy, on PAP usage in the real-world setting. Methods: Deidentified data for U.S.-based patients receiving PAP therapy were examined. Eligible patients were registered in the myAir app and provided self-reported sleepiness at baseline and after 7, 14, 21, and 28 days of PAP between November 2019 and April 2020. Results: A total of 95,397 registered patients metall eligibility criteria and were included in the analysis (mean age, 49.6 ± 13.0 yr; 61.6% male). Daytime sleepiness was the most common reason for PAP therapy initiation (57.1% of patients), and 42.2% of all patients had self-reported moderate to severe OSA. Self-reported sleepiness improved with PAP therapy in most patients over the assessment period, with 62.1% of patients reporting "no" or "slight" sleepiness at Day 28. There was a dose-dependent association between improvement in self-reported sleepiness at Day 28 and PAP usage, and this finding was maintained at Day 360. Self-reported sleepiness at Day 28 was associated with achieving U.S. Centers for Medicare & Medicaid Services compliance at 90 days (approximately 90% for those with no or slight sleepiness vs. <70% for those with residual very or extreme sleepiness); average daily PAP usage over 360 days was ⩾5.0 and ⩽3.7 hours, respectively, for those with no or slight versus very or extreme sleepiness. Conclusions: This study demonstrates the feasibility of capturing patient-reported outcomes via a digital platform. Patient-reported outcomes appear to be associated with PAP usage, especially self-reported sleepiness and its response to therapy. Capturing patient-reported outcomes using digital solutions during the course of treatment has the potential to enhance patient outcomes by providing actionable insights.