High Adherence With Integrated Sleep Practice-Supplied PAP Machines in Disturbed Sleep Breathing

James M Andry Jr, MD

Data from a recent study suggest that patients with disturbed sleep breathing (DSB) that received positive airway pressure (PAP) therapy machines from an integrated sleep practice (ISP) had greater adherence to the therapy than patients supplied by a traditional durable medical equipment (DME) supplier.

Researchers observed that the ISP group had a 71% (n = 1296) rate of PAP adherence at 30 days, a 66% (n = 1212) rate at 90 days, and a 52% (n = 961) rate at 1 year. These rates were significantly higher than those in the DME group, which had a 66% (n = 1327) rate of adherence at 30 days (P = .004), a 56% (n = 1116) rate at 90 days (P <.00001), and a 33% (n = 665) rate of adherence at 1 year (P <.00001). The ISP group also had a significantly duration of PAP use, with 357 minutes compared to 345 in the DME group at 30 days (P = .002), 348 compared to 319 at 90 days (P <.00001) and 312 compared to 164 at 1 year (P <.00001).

Lead author James M Andry Jr, MD, assistant professor of neurology, Vanderbilt University Medical Center, and colleagues wrote that “adherent patients tend to be more satisfied with the level of communication and education they have received from the providers and staff providing their sleep care. Practices may also be in a better position to address the common comorbid conditions that can affect PAP adherence. As such, sleep specialty clinics may be well equipped to deliver timely interventions to promote PAP adherence, provided they effectively leverage their interdisciplinary clinical team to address some of the common barriers to PAP adherence.”

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Andry and colleagues analyzed data from patients with DSB that initiated PAP therapy at the Sleep Centers of Middle Tennessee from January 1998 to June 2018. The ISP group consisted of 1833 patients with a mean age of 46.7 years, 1186 (64.7%) of which were men. The DME group consisted of 2055 patients with an average age of 47.4 years, 1235 of which were men. Both groups were predominantly White, with 1549 (84.5%) White patients in the ISP group and 1654 (80.5%) White patients in the DME group.

The researchers found that the ISP group had significantly higher rates of PAP adherence, with P values ranging from 0.00001 to 0.002 between ISP and DME groups. Adherence was defined as use of PAP therapy for at least 4 hours on at least 70% of days over the reported study intervals. 

Andry and colleagues conducted a subgroup analysis and found that rates of adherence did not statistically differ between Black patients in the ISP and DME groups at 30 days (P = .62) and 90 days (P = .75) but did statistically differ at 1 year (P = .008). However, the sample size of Black patients was significantly smaller than that of White patients, with 148 (8.1%) Black patients in the ISP group and 222 (10.8%) Black patients in the DME group.

Andry and colleagues also analyzed duration of use and found that the ISP group had longer median durations of PAP use, with P values ranging from 0.002 to 0.00001. Again, subgroup analyses revealed that no significant differences were seen between Black patients in the ISP and DME groups at 30 days (P = .62) and 90 days (P = .39) but were seen at 1 year (P = .001).

“Despite limitations, the study explored a pervasive issue, affecting both academic and community-based sleep practices. The interactions between the traditional DME providers and PAP adherence have been underexplored in the peer-reviewed literature. The large difference in long-term (1-year) adherence rates between groups, in particular, warrants further exploration into the role that the heterogeneous landscape of traditional DME providers plays in long-term PAP adherence. As current health care trends drive sleep medicine practices to adopt remote monitoring and chronic care management models, further studies are needed to better understand the tradeoffs of receiving PAP therapy through traditional DME providers,” Andry and colleagues concluded.

REFERENCE

Andry JM, Tobin G, Shafin C, Noah W. Positive airway pressure therapy supplied by an integrated sleep practice associated with greater adherence among pre–Medicare-aged patients with sleep-disordered breathing. J Clin Sleep Med. 2021. 17(1):31-36. doi: 10.5664/jcsm.8786