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Abstract
Introduction The most efficacious treatment for obstructive sleep apnoea (OSA) is Continuous Positive Airway Pressure (CPAP). CPAP’s benefit is curtailed however, because many patients do not adhere to treatment, estimated from trials at 17-85%.1 Since the Covid-19 pandemic, US and French CPAP adherence rates have been reported to have changed.2 We sought to determine CPAP adherence rates of NHS patients pre-and post-pandemic.
Methods 5 sleep centres were recruited. To detect an 18% difference [US Philips Respironics survey% adherent 36% (2019) vs 18% (2020)], 80% power, p 0.05%, 2-tailed test, n =92. Average use at Night 3, 7, 14, 1 and 3 months and clinical data collected from 100 patients starting CPAP for first time in i) April 2019 and ii) September 2020, using Resmed Airview and clinical records. Adherence defined as CPAP use ≥4 hrs/night for ≥70% of nights, or at Night 3 median use ≥4 hrs.
Results See table 1 for patient characteristics. In 2019, in all centres,% of adherent patients fell from Night 3 to 3 months, with 3-month adherence rates between 29%-50% (p=0.025, figure 1). Similar was seen in 2020 in Conquest (CH) and Musgrove Park hospitals (MSH); in CH, higher% seen up to 1 month compared to 2019. In 2020, at Manchester (MH), Derriford (DH) and Guys and St Thomas’s hospitals (GSTT) the% of adherent patients did not fall between Night 3 and 3 months; MH and DH maintained similar% to 2019, in GSTT, there was a smaller% starting at Night 3 compared to 2019 (30% vs 55%, p<0.0001). 2020 3-month adherence rates were different between centres (27-51%, p =0.004).
Percentage of patients adherent at each time point over 3 months at each centre and at all centres combined in 2019 compared to 2020 Abbreviations: GSTT: Guy’s and St Thomas’s Hospital, MH: Manchester Hospital, CH: Conquest Hospital, MSH: Musgrove Park Hospital, DH: Derriford Hospial Comparisons assessed using a Chi-square test (*p<0.05, **p<0.01, ***p<0.001). Significant differences between between 2019 and 2020 values denoted by asterisk(s) above the value. Significant differences between 2019 values denoted by a solid line drawn between timepoints compared and asterisk(s) above bar, and similarly significant differences between 2020 values denoted by a dashed line between timepoints compared and asterisk(s) above bar
Table of patient characteristics at each centre
Discussion 3 month adherence rates are low -at best 50%. Rates have changed at some centres since the pandemic, with change varying depending on the treatment pathway modifications implemented.
References
Weaver TE & Sawyer AM. Adherence to continuous positive airway pressure treatment for obstructive sleep apnoea: implications for future interventions. The Indian Journal of Medical Research 2010;131:245-258.
Attias D, Pepin JL & Pathak A. Impact of COVID-19 lockdown on adherence to continuous positive airway pressure by obstructive sleep apnoea patients. The European Respiratory Journal 2020;56: doi:10.1183/13993003.01607-2020
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