Use Of Positive Airway Pressure Therapy Research Articles

Computational design of custom-fit PAP masks

Positive airway pressure (PAP) therapy refers to sleep disordered breathing treatment that uses a stream of compressed air to support the airway during sleep. Even though the use of PAP therapy has been shown to be effective in improving the symptoms and quality of life, many patients are intolerant of the treatment due to poor mask fit. In this paper, our goal is to develop a computational approach for designing custom-fit PAP masks such that they can achieve better mask fit performance in terms of mask leakage and comfort. Our key observation is that a custom-fit PAP mask should fit a patient’s face in its deformed state instead of in its rest state since the PAP mask cushion undergoes notable deformation before reaching an equilibrium state during PAP therapy. To this end, we compute the equilibrium state of a mask cushion using the finite element method, and quantitatively measure the leakage and comfort of the mask cushion in this state. We further optimize the mask cushion geometry to minimize the two measures while ensuring that the cushion can be easily fabricated with molding. We demonstrate the effectiveness of our computational approach on a variety of face models and different types of PAP masks. Experimental results on real subjects show that our designed custom-fit PAP masks are able to achieve better mask fit performance than a generic PAP mask and custom-fit PAP masks designed by a state-of-the-art approach.

Effects of Positive Airway Pressure Therapy on Glycemic Variability in Patients With Type 2 Diabetes and OSA: A Randomized Controlled Trial

Glycemic variability is associated with increased risk for cardiovascular disease in patients with type 2 diabetes independent of glycosylated hemoglobin A1c (HbA1c) levels. Given the conflicting evidence on the effect of positive airway pressure (PAP) therapy for OSA on HbA1c, elucidating its effect on glycemic variability has value. Does the use of PAP therapy for OSA improve glycemic variability in patients with type 2 diabetes? A randomized controlled trial was conducted in 184 patients with type 2 diabetes and moderate-to-severe OSA. Participants received either 3months of PAP therapy with lifestyle counseling or lifestyle counseling alone. End points included the SD of glucose levels along with other metrics derived from continuous glucose monitoring and self-monitoring of blood glucose. No differences were noted in either primary or secondary continuous glucose monitoring end points between the two groups. Average use of PAP therapy was 5.4 h/night (SD, 1.6). Exploratory analyses by sex showed significant differences in the primary and secondary outcomes. In female participants, PAP therapy was associated with improvement in the SD of glucose levels, with a mean difference in change between intervention and control groups of 3.5mg/dL (P= .02). PAP therapy was also associated with lower post-dinner and bedtime glucose levels: 20.1mg/dL (P< .01) and 34.6mg/dL (P< .01), respectively. PAP therapy did not improve glycemic control or variability in patients with moderate-to-severe OSA and type 2 diabetes. Exploratory analyses suggested that PAP therapy may improve glucose variability in female participants. Post-dinner and bedtime glucose levels were higher in those who did not receive PAP therapy. ClinicalTrials.gov; No.: NCT02454153; URL: www. gov.

Association between positive airway pressure therapy adherence and health care resource utilization in patients with obstructive sleep apnea and type 2 diabetes in the United States.

There is a complex interplay between obstructive sleep apnea (OSA) and type 2 diabetes. There are minimal data regarding the effects of treating OSA with positive airway pressure (PAP) therapy on outcomes and health care resource utilization (HCRU) in patients with OSA and type 2 diabetes. We investigated the impact of PAP adherence on HCRU and costs in this population. A retrospective analysis was conducted with a cohort of OSA patient from a US administrative claims dataset linked to objective device data (AirView, ResMed Corp., San Diego, California). Propensity score matching was used to control for potential imbalance in baseline covariates between PAP-adherent and -nonadherent patients. Newly diagnosed patients with OSA aged ≥ 18 years with type 2 diabetes were included. PAP adherence was defined as meeting Centers for Medicare and Medicaid Services compliance criteria in all 8 90-day periods over 2 years. HCRU was based on the number of all-cause doctor visits, emergency room visits, inpatient hospitalizations, and PAP equipment and supplies. In years 1 and 2 of PAP therapy, HCRU was significantly lower in adherent vs nonadherent patients (number/patient for emergency room visits 0.68 ± 1.47 vs 0.99 ± 1.91 [year 1], 0.69 ± 1.43 vs 0.95 ± 1.89 [year 2]; for hospitalizations 0.16 ± 0.58 vs 0.22 ± 0.62 [year 1], 0.15 ± 0.51 vs 0.21 ± 0.74 [year 2]; all P < .001). Changes in estimated total 24-month payments were higher for nonadherent patients ($2,282, 95% confidence interval: $1,368, $3,205). Consistent use of PAP therapy over 2 years was associated with decreased HCRU in patients with OSA and type 2 diabetes, strongly suggesting a role for screening and treating OSA in type 2 diabetes. Sterling KL, Cistulli PA, Linde-Zwirble W, etal. Association between positive airway pressure therapy adherence and health care resource utilization in patients with obstructive sleep apnea and type 2 diabetes in the United States. J Clin Sleep Med. 2023;19(3):563-571.

0368 Leveraging the Electronic Health Record to Facilitate Shared-Medical Decision Making in a Large Health System: Response to the PAP Recall

Abstract Introduction The positive airway pressure (PAP) device manufacturer recall afflicting ~4 million users has posed a major challenge for the care of patients with sleep disordered breathing. We report on the Cleveland Clinic enterprise-wide response efforts and relevant predictors of medical decision-making surrounding this recall. Methods A taskforce developed a strategic response to the recall with the goal of distributing enterprise-wide communications; providing key guidance to providers and patients. For patients, a multi-pronged, tiered approach of MyChart messaging, phone and mailings instructing device registration and continuing use of PAP until discussed with the provider was implemented. For providers, an Epic smartphrase, embedded with a tracker, was developed as a resource including details of a decision-making algorithm while awaiting remediation. A team of mid-level providers was trained in the use of the algorithm; and the smartphrase was utilized for targeted virtual visits and communications. Presented is a retrospective cohort analysis of demographics and comorbid predictors between the group of patients advised to continue therapy, versus those advised to discontinue. Wilcoxon rank sum test or t-test was used for comparisons. Results 15,759 patients were contacted; message confirmed read/heard for 99.3%. Analysis of smartphrase use yielded 1135 instances (median,IQR): age:61.0 [51,70];48.5% female, 13.6% African American, body mass index(BMI) 33.5[29,38.9] kg/m2, apnea hypopnea index(AHI)=22.8[11.7,46.1] of whom n=770(67.8%) were advised to continued therapy. Predictors of provider guidance to continue versus temporarily hold PAP therapy respectively include: age:63[53,71] vs. 58[47,67] p&amp;lt;0.001, female:44% vs. 57%,p&amp;lt;0.001, BMI:33.9[29.5, 39.7] vs. 32.0[28.0,37.5],p&amp;lt;0.001, AHI:31.9[15.5, 58.0] vs.15.7[9.1,21.2],p&amp;lt;0.001 and the following comorbidities: hypertension:61.0% vs. 46.3%,p&amp;lt;0.001, coronary artery disease,11.3% vs. 3.6%,p&amp;lt;0.001,heart failure:2.6% vs. 0.6%,p&amp;lt;0.001, atrial fibrillation:9.5% vs. 2.5%,p&amp;lt;0.001 and chronic obstructive pulmonary disease:5.8% vs. 1.6%,p&amp;lt;0.001,but not diabetes. Conclusion We conclude that EHR tools can be used to coordinate device recall response efforts and guide both providers and patients. The use of a system smartphrase facilitated provider-patient shared medical decision-making to continue versus temporarily discontinue use of PAP therapy efficiently. Those advised to continue PAP therapy had higher burden of sleep apnea and cardiopulmonary comorbidity. Support (If Any)

Factors determining the long-term compliance with PAP therapy in patients with sleep-related epilepsy

IntroductionIn adult patients with epilepsy, treatment of comorbid obstructive sleep apnea syndrome (OSAS) by positive airway pressure (PAP) therapy results in improvements in the control of seizures. This is the first study investigating the long-term compliance with PAP therapy in patients with sleep-related epilepsy and OSAS. MethodsIn this longitudinal study, patients with sleep-related epilepsy and OSAS were followed-up for five years. The compliance with PAP therapy was defined as the use of PAP therapy for at least four hours per night for more than 70 % of nights. ResultsA total of 58 patients with sleep-related epilepsy and OSAS completed study protocol. Eleven patients (19.0 %) refused PAP treatment for OSAS, and 13 patients (22.3 %) showed irregular use. Remaining 34 patients (58.7 %) were compliant with PAP therapy. Females were found to be more compliant than males (p = 0.027), while the age was not found to correlate with the compliance (p = 0.721). Epilepsy-related factors including the types of seizures, whether pure sleep-related or mixed (p = 0.403), localization (p = 0.920) or lateralization (p = 0.697) of discharges, showed no effect on the compliance with PAP therapy. On the other hand, patients with a lower number of seizures (p = 0.042) or with a lower seizure frequency (p = 0.048) showed better compliance with PAP therapy. Polysomnographic parameters including severity of OSAS failed to show a significant correlation. ConclusionOur findings showed that about two thirds of the study population was compliant with PAP therapy after a mean follow-up duration of almost three years. Newly-diagnosed patients, mostly females, with a lower number of total seizures and lower seizure frequency seem to be more compliant with PAP therapy, which implies the significance of investigation and treatment of OSAS as early as possible in the patients with sleep-related seizures.

0644 An Educational and Behavioral Intervention Failed to Improve PAP Use Among Veterans With Spinal Cord Injuries and Diseases: Results of a Randomized Controlled Trial

Abstract Introduction Sleep disordered breathing (SDB) is common among individuals with spinal cord injuries or diseases (SCI/D), many of whom are military Veterans, and physical limitations make use of positive airway pressure (PAP) therapy challenging. This study sought to test the effects of an educational and behavioral intervention to improve PAP adherence among Veterans with SCI/D over the first 3 months of use. Methods 63 Veterans (mean age=60.7(10.2) years; 92% male) with SCI/D (33 SCI, 30 SCD; 25 cervical involvement; 38 thoracic and below) and SDB (23 with AHI 5-15; 40 with AHI&amp;#8805;15) who received PAP treatment (CPAP or BPAP) were randomly assigned to receive a comprehensive 3-month intervention (INT) or an equal attention control (EAC). INT and EAC both included 1 face-to-face session (week 1) and 5 additional telephone sessions (weeks 2, 3, 4, 8 and 12). Main outcome measures were PAP use over the first 3 months: nights of use, nights of use &amp;#8805;4 hours, and mean hours of use per night. Repeated measures ANCOVA models were used to test the differences between INT and EAC over the first 3 months of treatment. Results Number of nights with &amp;#8805;4 hours of use in months 1-3 was 9, 7, and 6 nights in the INT and 8, 5 and 4 nights in the EAC (p’s&amp;#8805;.37), respectively. There were no significant differences between INT and EAC for number of nights with any use (p’s&amp;#8805;.24), or mean hours of use per night (p’s&amp;#8805;.30). All 3 PAP use variables declined over time in both groups. Conclusion Sustained use of PAP therapy was difficult to achieve among those with SCI/D, and a 6-session behavioral intervention did not lead to significant improvements in use. Even when relatively high levels of initial use are achieved, this is difficult to sustain over time. Future studies should explore whether SCI/D patients experience significant symptom relief with PAP, and if so, whether home-based interventions or more intensive face-to-face PAP adherence programs will be effective. Support VA Rehabilitation Research and Development Service, Merit Review (1RX002116; PI: Badr); NIH/NHLBI K24 HL143055 (Martin).

PAP therapy increases the risk of transmission of COVID-19.

Positive airway pressure (PAP) therapy is an open system that can generate contact, droplet, and airborne COVID-19 thereby increasing the risk of transmission of COVID-19 like other procedures such as tracheal intubation, noninvasive ventilation, and cardiopulmonary resuscitation. Medically prudent recommendations have been established for home use of PAP therapy in asymptomatic patients and patients with suspected or confirmed COVID-19. Recommendations for sleep clinics and sleep laboratory activities are also discussed as well as the emergency use of PAP devices as a substitute for ventilation.

How to use noninvasive positive airway pressure device data reports to guide clinical care.

There has been a significant increase in the past few decades in the number of children receiving noninvasive positive airway pressure (PAP) therapy at home. At present, PAP therapy can be successfully used in children of all ages, for a variety of indications. Data acquired from PAP devices is clinically useful, providing objective information regarding adherence, leak, and efficacy of PAP therapy. However, guidelines outlining a standardized approach to interpretation of PAP device data in pediatrics is currently lacking. Given the rapidly expanding use of PAP therapy in pediatric practice, we aim to provide an overview of the interpretation of data reports, otherwise called "data downloads," from PAP devices and illustrate how they can be used to guide clinical care.

Non-invasive ventilation for obese patients with chronic respiratory failure: Are two pressures always better than one?

Obesity-related respiratory failure is increasingly common but remains under-diagnosed and under-treated. There are several clinical phenotypes reported, including severe obstructive sleep apnoea (OSA), isolated nocturnal hypoventilation with or without severe OSA and OSA complicating chronic obstructive pulmonary disease (COPD). The presence of hypercapnic respiratory failure is associated with poor clinical outcomes in each of these groups. While weight loss is a core aim of management, this is often unachievable, and treatment of sleep-disordered breathing with positive airway pressure (PAP) therapy is the mainstay of clinical practice. Although there are few long-term clinical efficacy trials, the lack of equipoise would prevent the utilization of an untreated control group. The current data support the use of PAP therapy to improve respiratory failure and is associated with improvements in health-related quality of life, reduced healthcare utilization and reduced mortality. Both continuous PAP (CPAP) and non-invasive ventilation (NIV) appear safe and effective in patients with obesity-related respiratory failure and OSA, with or without COPD, and the current evidence would not support a single therapy choice in all patients. There are no studies of CPAP in patients with isolated nocturnal hypoventilation, and NIV would be the current recommendation in this patient group. Whichever starting therapy is used, titration should be performed to correct sleep-disordered breathing and reverse chronic respiratory failure, with consideration of step-down of the treatment based on a clinical re-evaluation. In contrast, failure to reach physiological and clinical treatment targets should lead to the consideration of treatment escalation.

Voice Disorders in Obstructive Sleep Apnea: Prevalence, Risk Factors, and the Role of CPAP.

Obstructive sleep apnea (OSA) is characterized by frequent interruptions in breathing related to upper airway collapse during sleep and may adversely affect phonatory function. This study aimed to: (1) establish the prevalence, risks, and quality of life burden of voice disorders in OSA and (2) explore the relation between voice disorders and positive airway pressure (PAP) therapy. Cross-sectional, descriptive epidemiology study. Analyses were based on 94 individuals with OSA (53 men, 41 women; mean age = 54.7 ± 12.8 years) who completed a telephone interview. Twenty-eight percent of participants reported having a current voice disorder. Of those with a current voice disorder, 83% had experienced symptoms for at least a year, and 58% had symptoms for at least 4 years. The prevalence of a current voice disorder was greater in women than men (44% vs 15%, P = .0020) but did not vary significantly across different age groups, body mass index (BMI), apnea/hypopnea index (AHI) severity, or medical history. After adjusting for sex, consistent use of PAP therapy (with humidification) was associated with (1) lower occurrence of voice disorders in women (Mantel-Haenszel [MH] χ2P = .0195), (2) reduced snoring severity accompanied by fewer voice disorders in men (MH χ2P = .0101), and (3) fewer reports of acid reflux as a possible trigger for voice problems (MH χ2P = .0226). Patients with OSA who also had a current voice disorder experienced lower overall quality of life compared to those without. Chronic, longstanding voice disorders are common in women with OSA and produce significant adverse effects on quality of life. Nightly PAP use (with humidification) was associated with fewer voice symptoms and reduced severity of snoring and acid reflux as possible contributors. Further research is necessary to better understand the origin of these voice disorders in OSA and their potential response to treatment.

Impact of PAP therapy on hospitalization rates in Medicare beneficiaries with COPD and coexisting OSA.

Growing evidence supports that patients with chronic obstructive pulmonary disease (COPD) and coexisting obstructive sleep apnea (OSA) have poor prognosis. This association is described as overlap syndrome. Positive airway pressure (PAP) therapy is now the preferred treatment for OSA. We hypothesized that use of PAP therapy in elderly patients with overlap syndrome would be associated with lower healthcare utilization. In this retrospective cohort study, we analyzed data from 5% national sample of fee-for-service Medicare beneficiaries with a diagnosis of COPD who were newly started on PAP therapy in 2011. We examined the effect of PAP therapy on emergency room (ER) visits and hospitalizations for all-cause and COPD-related conditions in the 1year pre- and 1year post-initiation of PAP therapy. In year 2011, we identified 319 patients with overlap syndrome who were new users of PAP therapy. In this cohort of patients, hospitalization rates for COPD-related conditions were significantly lower in the 1year post-initiation of PAP therapy compared to the 1-year pre-initiation period (19.4 vs 25.4%, P value =0.03). However, ER visits (for any cause or COPD-related conditions) and hospitalization rates for any cause did not differ significantly in the pre- and post-initiation periods. PAP therapy was more beneficial in older adults, those with higher COPD complexity, and those with three or more comorbidities. Initiation of PAP therapy in elderly patients with overlap syndrome is associated with a reduction in hospitalization for COPD-related conditions, but not for all-cause hospitalizations and ER visits.

Sleep Apnea in Heart Failure.

In this review, we discuss the current treatment options for sleep-disordered breathing (SDB) in patients with heart failure (HF). We address the role of positive airway pressure (PAP) devices and other emerging therapies. The review includes discussion of recent trials that reported negative consequences for the PAP devices in patients with heart failure. Optimal guideline-directed medical therapies of HF and PAP devices have been the mainstay treatments for HF patients with SDB. Recently, randomized controlled trials (RCTs) evaluated the effect of PAP on clinical outcomes in patients with cardiovascular (CV) disease and heart failure and found no benefit in decreasing fatal and non-fatal CV events. The Sleep Apnea Cardiovascular Endpoints (SAVE) trial evaluated continuous positive airway pressure (CPAP) ventilation in patients with CV disease and obstructive sleep apnea (OSA) and did not observe any improvement in CV effect. In patients with HF and central sleep apnea (CSA), adaptive servo-ventilation (ASV) was hypothesized to help HF outcomes, but the Adaptive Servo-Ventilation for Central Sleep Apnea in Systolic Heart Failure (SERVE-HF) trial did not show any mortality benefit. Instead, the trial suggested an increase in all-cause and CV mortality in the treatment arm. currently, studies have not shown the use of PAP therapy to improve any risks of CV outcomes or death in HF patients with sleep apnea, but some associations with improvements in symptoms from OSA have been observed.

Domiciliary noninvasive positive airway pressure therapy in children.

There has been a dramatic increase in the past few decades in the number of children receiving noninvasive positive airway pressure (PAP) therapy at home. Although PAP therapy was first prescribed for children with obstructive sleep apnea, the indications have rapidly widened to include treatment for central hypoventilation syndromes, neuromuscular and chest wall disorders as well as primary respiratory diseases. Given the rapidly expanding use of PAP therapy in children, pediatric pulmonologists need to be familiar with the indications, technical and safety considerations as well as potential complications and challenges that may arise when caring for children using PAP therapy. This review article covers the definition of PAP therapy, modes, interfaces, devices, indications, contraindications, suggested settings, complications as well as the factors influencing the adherence.

Positive Airway Pressure Therapy for Perioperative Patients

Positive airway pressure (PAP) therapy can be administered as a fixed pressure level, a variable autotitrating pressure, or a bilevel setting. Evidence for use of PAP therapy in postoperative patients comes from patients with postextubation respiratory failure or from preemptive efforts to prevent reintubation. Patients with obstructive sleep apnea (OSA) or other forms of sleep-disordered breathing are recognized as having additional risks for postoperative complications. Protocols are being proposed to manage postoperative patients with known or suspected OSA with PAP therapy. The role of preoperative diagnosis of OSA and preoperative PAP therapy treatment is also being explored.

Prognostic impact of sleep disordered breathing and its treatment in heart failure: an observational study

Sleep disordered breathing (SDB) may contribute to disease progression in patients with chronic heart failure (CHF). The objective of this observational study was to evaluate whether SDB is a risk factor for mortality in CHF patients and whether this risk can be attenuated by treatment with positive airway pressure (PAP). We studied 296 CHF patients (median left ventricular ejection fraction 33%) who underwent in-lab polysomnography between January 2002 and December 2009. We compared (i) mortality between patients with severe SDB [apnoea-hypopnoea index (AHI) ≥ 22.5 h(-1)] vs. those without severe SDB (AHI < 22.5 h(-1)) and (ii) evaluated the impact of PAP treatment on mortality in those with severe SDB. After accounting for significant confounding factors (age, NYHA class, cause of CHF, diabetes, and PAP treatment), patients with severe SDB (n= 176) had a 2.0-fold increased hazard ratio for death compared with those without severe SDB [95% confidence interval (CI) 1.1-3.5, P= 0.023]. In an adjusted on-treatment analysis of the group with severe SDB, mortality was significantly less in patients using PAP (18%) compared with those with untreated SDB (52%; hazard ratio 0.4, 95% CI 0.2-0.6, P= 0.001). Mortality in the PAP-treated group was lower compared with the untreated group at any time-point of the follow-up period. The presence of severe SDB in CHF patients constitutes a significantly increased risk for death, independent of established risk factors. In CHF patients with SDB, use of PAP therapy was associated with a decreased mortality rate at any time point of the follow-up, suggesting that PAP can be safely used in such patients.

Treatment of Obstructive Sleep Apnea and Hypopnea—We Are Not There Yet!

Recently available data from a number of studies provide convincing evidence that obstructive sleep apnea hypopnea (OSAH) is an independent risk factor for the development of cardiovascular disease (CVD) and for increased mortality.1–3 Even if the prevalence of OSAH is assumed to be 2% to 4% in the general population, an arguably conservative estimate, OSAH is a significant public health concern. Initial consideration of these findings would suggest that we as Sleep Medicine practitioners should be as diligent in identifying and prescribing treatment for OSAH as internists and family practitioners are for treatment of elevated lipids and hypertension. As much as this strategy is attractive from a scientific perspective, there are some important gaps in our knowledge with respect to the impact of OSAH on all segments of the population as well as practical barriers that preclude implementation. Although recent prospective observational studies have demonstrated that OSAH appears to be an independent risk factor for CVD and increased mortality,2,3 it is not clear that the impact is uniform across all segments of the population. Data presented last year by the Sleep Heart Health Study indicate that the impact of OSAH on mortality and incident CVD is primarily found in men less than 70 years of age, with little effect in women and older men.4 The absence of an adverse impact on older men is consistent with a previous study in a large clinical cohort.1 Furthermore, longitudinal studies of clinical populations demonstrating an adverse impact of OSAH on CVD and mortality have been performed in cohorts comprised predominantly or entirely of men.1,5,6 Thus, it can be argued that the adverse impact on mortality and incident CVD, if any, of OSAH on women, and perhaps older men remains to be determined. Perhaps an equally vexing issue for Sleep Medicine practitioners is the question of who to treat. Review of the data from several longitudinal studies suggest that the mortality and CVD risks for persons with an AHI < 15 may be very low or absent. For example, in the frequently cited study by Marin et al, increased risk of incident CVD and mortality appeared to be present only in those with an AHI ≥ 30.5 Moreover, in the Busselton study, an increase in all-cause mortality was associated only with a RDI ≥ 15.2 Many individuals with OSAH are not sleepy or feel unrested7 and present for medical attention for other reasons. Can we justify treatment of mild OSAH in those with the absence of these symptoms given the lack of definitive evidence of an adverse CVD or mortality impact in this group? In particular, should older persons and women with mild OSAH be treated? The question of who to treat would be less of an issue if available treatment modalities were plentiful and highly effective. Unfortunately, neither is the case. There are 4 commonly employed therapeutic modalities for OSAH: weight loss, upper airway surgery, oral appliances, and positive airway pressure (PAP). Excluding surgical procedures for weight loss, diet programs have not been highly effective. Upper airway surgery is only modestly efficacious at best, and even less effective.8 Oral appliances and PAP therapy are highly efficacious, but their clinical effectiveness rates are less than desirable.9,10 Long-term use of PAP therapy in some studies is reported to be only ∼60%.10 This latter observation is now reflected in Medicare regulations, which require documentation of both treatment compliance and improvement in symptoms for continued reimbursement for PAP therapy. The aforementioned realities present significant challenges to the field of Sleep Medicine. One of our most important disease conditions is highly prevalent in the general population, but it is unclear whether all persons should be treated. Moreover, available treatment modalities are limited and are not highly effective. Recently published studies have provided important information concerning the health impact of OSA, but we are not there yet' Many unresolved issues remain. Additional research and development will be required from both the scientific community and industry to effectively treat the epidemic of OSA.

A Daytime, Abbreviated Cardio-Respiratory Sleep Study (CPT 95807–52) To Acclimate Insomnia Patients with Sleep Disordered Breathing to Positive Airway Pressure (PAP-NAP)

To assess the impact of a daytime sleep medical procedure--the PAP-NAP--on adherence to positive airway pressure (PAP) therapy among insomnia patients with sleep disordered breathing (SDB) METHODS: The PAP-NAP is based on Current Procedural Terminology (CPT) codes and combines psychological and physiological treatments into one procedure, which increases contact time between SDB patients and polysomnography technologists to enhance PAP therapy adherence. Using a Sleep Dynamic Therapy framework, explicating SDB as a mind-body disorder, the PAP-NAP includes mask and pressure desensitization, emotion-focused therapy to overcome aversive emotional reactions, mental imagery to divert patient attention from mask or pressure sensations, and physiological exposure to PAP therapy during a 100-minute nap period. Patients treated with the PAP-NAP test (n = 39) were compared to an historical control group (n = 60) of insomnia patients with SDB who did not receive the test. All 99 insomnia patients were diagnosed with SDB (mean AHI 26.5 +/- 26.3, mean RDI 49.0 +/- 24.9), and all reported a history of psychiatric disorders or symptoms as well as resistance to PAP therapy. Among 39 patients completing the PAP-NAP, 90% completed overnight titrations, compared with 63% in the historical control group; 85% of the nap-tested group filled PAP therapy prescriptions for home use compared with 35% of controls; and 67% of the nap-tested group maintained regular use of PAP therapy compared with 23% of the control group. Using standards from the field of sleep medicine, the nap-tested group demonstrated objective adherence of 49% to 56% compared to 12% to 17% among controls. All studies were reimbursed using CPT 95807-52. In this pilot study, the PAP-NAP functioned as a brief, useful, reimbursable procedure to encourage adherence in insomnia patients with SDB in comparison to an historical control group that did not undergo the procedure.