Elsevier

Sleep Medicine

Volume 59, July 2019, Pages 114-116
Sleep Medicine

Brief Communication
Short-term CPAP adherence in obstructive sleep apnea: a big data analysis using real world data

https://doi.org/10.1016/j.sleep.2019.01.004Get rights and content

Highlights

  • CPAP adherence is critical for attainment of health benefits in OSA.

  • In a large database, 75% of those initiating CPAP therapy met the US Center for Medicare and Medicaid Services (CMS) definition of adherence.

  • Patients used CPAP for a mean of 5.1 hours per night.

  • Real world CPAP adherence is acceptable and compares favorably to pharmacotherapy in other chronic diseases.

Section snippets

Background

Effective treatment of obstructive sleep apnea (OSA) is an important goal due to its impact on quality of life, and the known cardiovascular and neurocognitive consequences of this common chronic disease. OSA is also associated with an increasing economic and social burden, estimated to be over $12 billion in the US in 2015 [1]. Continuous positive airway pressure (CPAP) has excellent efficacy for controlling OSA, but its effectiveness is limited by variable adherence to therapy. The fact that

Methods

We assessed de-identified data from a large cloud database of positive airway pressure (PAP) users to examine adherence to therapy during the period 1-Oct-2014 to 31-Oct-2017. AirView (ResMed Inc., San Diego, USA) is a HIPAA-compliant web-based solution for healthcare specialists intended to transfer and display device and therapeutic information that has been transmitted remotely from the patient's therapy device. All Air10 platform PAP devices (ResMed Inc., San Diego, USA) have an on-board

Results

During the period of analysis, 2.62 million patients met the inclusion criteria; 23.4% of patients were excluded for the following reasons: >1 HME (1.9%), invalid data entry (10.1%), more than one PAP modality used or data from SD card (9.2%), age ≤18 years (0.7%), <1 hour usage in first 90 days (1.4%). The mean (±SD) age was 55.7 ± 13.8 years. The following single PAP modalities were used: APAP (50%), CPAP (41%), bilevel (5.6%), bilevel Auto (2.4%), ASV (0.7%), ASV Auto (0.5%).

The observed

Discussion

To our knowledge this is the largest analysis of objective CPAP usage ever undertaken using real world data. The short term adherence rate of 75% in this analysis appears higher than is generally acknowledged in clinical practice and reported in the literature. The observed treatment characteristics in our study demonstrate excellent efficacy during therapy, with a mean residual AHI of 3.2/hour and acceptable leaks. The mean usage of 5.1 hours is also higher than that found in a meta-analysis

Acknowledgements and disclosures

The authors wish to thank the following for statistical analysis: Haixiang Shi, PhD and Yang Yan, M. Sc. Stat. Authors JA and AB had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. ResMed Corp, USA funded the study and their employees (JA, AB, CMN) contributed to the design and conduct of the study, analysis, and interpretation of the data and preparation of the manuscript for publication. PAC has an

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