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. 2023 Mar;27(1):303-308.
doi: 10.1007/s11325-022-02608-z. Epub 2022 Mar 26.

Impact of mail-based continuous positive airway pressure initiation on treatment usage and effectiveness

Lucas M Donovan  1   2 , Elizabeth C Parsons  3   4 , Catherine A McCall  3   4 , Ken He  3   4 , Rahul Sharma  3   4 , Justina Gamache  3   4 , Anna P Pannick  3 , Jennifer A McDowell  3 , James Pai  3 , Eric Epler  3 , Kevin I Duan  3   4 , Laura J Spece  3   4 , Laura C Feemster  3   4 , Vishesh K Kapur  4 , David H Au  3   4 , Brian N Palen  3   4
Affiliations

Impact of mail-based continuous positive airway pressure initiation on treatment usage and effectiveness

Lucas M Donovan et al. Sleep Breath. 2023 Mar.

Abstract

Purpose: In-person visits with a trained therapist have been standard care for patients initiating continuous positive airway pressure (CPAP). These visits provide an opportunity for hands-on training and an in-person assessment of mask fit. However, to improve access, many health systems are shifting to remote CPAP initiation with equipment mailed to patients. While there are potential benefits of a mailed approach, relative patient outcomes are unclear. Specifically, many have concerns that a lack of in-person training may contribute to reduced CPAP adherence. To inform this knowledge gap, we aimed to compare treatment usage after in-person or mailed CPAP initiation.

Methods: Our medical center shifted from in-person to mailed CPAP dispensation in March 2020 during the COVID-19 pandemic. We assembled a cohort of patients with newly diagnosed obstructive sleep apnea (OSA) who initiated CPAP in the months before (n = 433) and after (n = 186) this shift. We compared 90-day adherence between groups.

Results: Mean nightly PAP usage was modest in both groups (in-person 145.2, mailed 140.6 min/night). We did not detect between-group differences in either unadjusted or adjusted analyses (adjusted difference - 0.2 min/night, 95% - 27.0 to + 26.5).

Conclusions: Mail-based systems of CPAP initiation may be able to improve access without reducing CPAP usage. Future work should consider the impact of mailed CPAP on patient-reported outcomes and the impact of different remote setup strategies.

Keywords: Adherence; Care pathways; Continuous positive airway pressure; Obstructive sleep apnea; Remote care; Sleep medicine.

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Conflict of interest statement

Dr. Au reports personal fees from Boehringer Ingelheim for service on an advisory board and personal fees from Annals of the American Thoracic Society for service as a deputy editor. This work received continuous positive airway pressure download data for our patient population from ResMed (San Diego, CA). All other authors declare no competing interests.

Figures

Fig. 1
Fig. 1
CPAP usage, leak, and residual apnea hypopnea index between groups. Legend: CPAP—continuous positive airway pressure; Min—minutes; L—liter; rAHI, residual apnea hypopnea index. All measures detected by CPAP device. Error bars represent 95% confidence intervals of sample mean
See this image and copyright information in PMC

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