Positive airway pressure compliance, adherence increases with less sleepiness early on
Click Here to Manage Email Alerts
Key takeaways:
- Reporting less sleepiness after 28 days of positive airway pressure therapy resulted in longer, sustained usage.
- High sleepiness levels at this point translated into poor therapy compliance and adherence rates.
Patients who reported lower levels of sleepiness after 1 month of positive airway pressure therapy showed high compliance at day 90 and adherence at day 360, according to results published in Annals of the American Thoracic Society.
“This study highlights the feasibility of engaging with patients to provide important information via an app, particularly focused around patient-reported outcome measures,” Peter A. Cistulli, MD, PhD, professor of sleep medicine in the Charles Perkins Centre at The University of Sydney, told Healio. “The study also demonstrates the importance of monitoring patient-reported outcomes over time, in this case focused on the symptom of sleepiness over the first month of CPAP therapy.”
In a real-world study, Cistulli and colleagues assessed 95,397 patients (mean age, 49.6 years; 61.6% men) with OSA receiving positive airway pressure (PAP) to determine how changes in patient-reported sleepiness, conveyed through the myAir app (ResMed), are related to PAP compliance (≥ 4 hours of PAP on 70% of nights for a consecutive 30 days) at day 90 and PAP adherence (continued use) at day 360.
Researchers had patients report their sleepiness on the app at baseline and every 7 days up to day 28 while using PAP.
Within the total cohort, the median self-reported apnea-hypopnea index (AHI) was 21 events per hour, which falls into the moderate OSA severity level. Overall, 19.9% of patients had moderate OSA (AHI, 15 to < 30 events per hour) and 24.4% had severe OSA (AHI, ≥ 30 events per hour).
Many patients started PAP because of daytime sleepiness (57.1%), but other reported reasons included restless sleep (40.2%), an ongoing health issue (35.6%) and disturbing their partner’s sleep (32.3%).
Researchers compared the baseline median sleepiness score with the day-28 score and found a reduction from 2 to 1 (P < .001). Further, more patients at day 28 vs. baseline reported no sleepiness (21.7% vs. 7.1%) or slight sleepiness (40.4% vs. 20.7%).
Researchers also found that improved levels of self-reported sleepiness at day 28 were linked to better PAP usage, whereas worse levels of sleepiness at this point were linked to poor PAP usage, both of which continued to be seen at day 360.
Rates of compliance at day 90 were higher among those with no (90.6%) or slight (87%) sleepiness compared with patients who reported being very (68.7%) or extremely (58.1%) sleepy (P < .001).
Average daily PAP usage over 90 days also decreased as patients reported poorer sleepiness outcomes, from 5.9 hours for those reporting no sleepiness to 3.8 hours among those reporting being extremely sleepy (P < .001), with this trend persisting at 360 days.
At day 360, 76.8% of patients who reported no sleepiness at day 28 achieved adherence, compared with only 50.3% of those who reported being very sleepy and 40.3% of those reported being extremely sleepy (P < .001).
Patients who became less sleepy over 28 days had increased odds for achieving PAP compliance by day 90 (adjusted OR = 1.76; 95% CI, 1.73-1.8) and adherence by day 360 (aOR = 1.51; 95% CI, 1.49-1.54) vs. those with no self-reported changes, whereas changes in sleepiness signaling worsening (more sleepy) meant reduced odds for both milestones.
“We found that the extent of improvement in sleepiness was associated with adherence to therapy,” Cistulli told Healio. “Collectively, these findings can make a positive impact on clinical care as better adherence produces better outcomes, which is what physicians strive for.”