0510 Effect of Sleep Coaches Using Cloud-Based Monitoring on PAP Adherence

Abstract

Introduction: Positive airway pressure (PAP) treatment for obstructive sleep apnea (OSA) in the VA Health Care System is challenging due to high demand/ limited resources and delay in timely communication of PAP problems. The 4 PAP respiratory therapists (RTs) at the Gainesville VAMC provide durable medical equipment (DME) services for over 5000 patients, making timely response to new PAP-user issues difficult. The Patient Adherence Management System utilizes protocol-driven centralized sleep coaches (CSC) who monitor adherence via a wireless PAP data program and provide live telephone contact on Days 3,7,14, and 30 after PAP setup to identify issues and encourage adherence. PAP issues not resolved by CSC are escalated to the DME/sleep provider. We hypothesized the CSC system improves PAP adherence in treatment-naive patients. Method(s): A randomized prospective protocol comparing: Arm 1: standard PAP care (SPC) including PAP setup by PAP RT, wireless adherence monitoring, and a PAP help line. Arm 2: SPC + CSC. At PAP setup patients electing to participate signed an informed consent and were randomized to SPC or SPC+ CSC. The primary endpoint was 3-month adherence, and secondary endpoints were the change in Epworth sleepiness scale (ESS) and patient satisfaction. Result(s): 117 patients were randomized (SPC+CSC n= 59, SPC n=58). The baseline characteristics SPC+CSC versus SPC (mean +/- SD) for age (54.4 +/- 10.7 versus 56.4 +/- 13.6 yrs), diagnostic AHI (40.1 +/- 23.4 versus 39.9 +/- 24.7 #/hr), and ESS (11.4 +/- 5.9 versus 10.6 +/- 5.9) did not differ. At 3 months the % of participants with >= 70% of nights with >= 4 hrs of use (SPC+CSC 67.8 % versus SPC 46.6%, P=0.025) and average use among all nights (4.5 +/- 2.4 versus 3.3 +/- 2.6 hrs, P=0.022) were higher in the CSC arm. The residual AHI and improvement in ESS did not differ. The percentage of patients satisfied/very satisfied with their therapy was higher in the SPC+CSC group (88.5% versus 67.3%, P=0.01) Conclusion(s): Addition of the CSC system to standard care significantly improves PAP adherence at 3 months.