Defining the core components of a clinical review of people using continuous positive airway pressure therapy to treat obstructive sleep apnea: An international e-delphi study

Abstract

Study Objectives: Guidelines recommend regular review of individuals using continuous positive airway pressure (CPAP) to treat obstructive sleep apnea but do not agree on the core components and frequency. We aimed to achieve consensus on essential components and frequency of review. Methods: We used an e-Delphi approach, recruiting a multidisciplinary international expert panel to identify components based on a list compiled from guidelines and to score these on a scale 1 to 5 over three rounds. Consensus was defined as ≥ 75% agreement for scores of 4 or higher. Free-text comments were thematically analyzed. Results: Forty participants completed 3 rounds scoring 36 potential components. Seventeen components achieved consensus: Treatment acceptability, sleep quality, symptom resolution (including reduction in apnea-hypopnea index), assessment of sleepiness (including when driving), technical CPAP issues (mask fit/humidification/cleaning/filters), recording CPAP adherence, and quality of life. Participants suggested 12 to 18 monthly reviews (more frequent when commencing CPAP) or "on demand." Free-text comments highlighted that reviews should be multidisciplinary, flexible (including telehealth), and focus on symptom control. Conclusions: We mapped 17 prioritized components to a suggested template that may support clinical reviews. Reviews should be flexible, frequently in the early stages of commencing CPAP, shifting to "on demand" and/or remote follow-up for maintenance. Our findings may inform future guideline recommendations for reviewing CPAP users.