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Background CPAP effectiveness is limited by suboptimal adherence. Prior studies of adherence have focused on middle-aged men. Research Question Does CPAP adherence vary by age and sex? Study Design and Methods Telemonitoring data from a CPAP manufacturer database were used to assess adherence in patients initiating CPAP therapy between November 2015 and October 2018. Analyses were restricted to patients in the United States aged 18 to 90 years. Results Across 789,260 patients initiated on CPAP (mean age, 55 ± 14 years; 58.2% male), overall adherence by US Centers of Medicare & Medicaid Services criteria was 72.6%, but it varied dramatically by age and sex, ranging from 51.3% in 18- to 30-year-old women to 80.6% in 71- to 80-year-old men. Patterns of use over the first 90 days demonstrated that younger age groups had peak CPAP use by the 2nd night, with a subsequent decay in use, including abandonment of CPAP, which was greatest among 18- to 30-year-old women. In contrast, older patients steadily increase use, taking more than a week to maximize usage, and then they have much slower decays in use over time. Younger, but not older, patients have lower use of CPAP on weekends compared with weekday nights. Interpretation CPAP adherence rates vary substantially by demographics, with 18- to 30-year-old women having the lowest adherence. The pattern of use over the first 90 days also varies substantially by age and sex. Further research to understand and address the causes of disparities will be crucial to maximizing the benefits of CPAP therapy.

CPAP therapy has remained the standard of care for the treatment of sleep apnea for nearly 4 decades. Its overall effectiveness, however, has been limited by incomplete adherence despite many efforts to improve comfort. Conventional alternative therapies include oral appliances and upper airway surgeries. Recently, several innovative alternatives to CPAP have been developed. These novel approaches include means to increase arousal thresholds, electrical nerve stimulation, oral vacuum devices, and nasal expiratory resistive devices. We will review the physiologic mechanisms and the current evidence for these novel treatments.

Although NCPAP is the most efficient nonsurgical treatment for patients with OSA, many patients do not accept sleeping with a nose mask. To determine the factors influencing acceptance, treatment with NCPAP was offered to 95 patients with an AHI greater than 15. After the first night on NCPAP, 47 of 65 patients decided to have NCPAP as a home therapy. Excessive daytime sleepiness was more frequently reported by acceptors than refusers. The frequency of complaints about psychomental symptoms such as poor mental performance and bad memory, was not different between the two groups. There was a close correlation between the rate of acceptance and the AHI as well as the number of positive answers to questions about symptoms of daytime sleepiness in a questionnaire, which correlated with the number and length of apneas. Acceptance of NCPAP was found to be dependent on the subjective feeling of impairment by hypersomnolence due to OSA.

SESSION TITLE: OSA Posters SESSION TYPE: Poster Presentations PRESENTED ON: Saturday, March 22, 2014 at 01:15 PM 02:15 PM PURPOSE: Obstructive Sleep Apnea (OSA) represents a perioperative risk. Continuous positive airway pressure (CPAP) therapy has demonstrated its ability to reduce this risk. However, many patients don’t adhere to this treatment. Our study was designed to identify patients with poor adherence to CPAP therapy. METHODS: After IRP approval and informed consent, we include 90 consecutive patients who were treated by CPAP for over a year. According to a CPAP use of more or less than 4 hours per night, they were split into two groups: adherent or non-adherent. 62 potential causes of non-adherence were listed and presented to patients. The questions were divided into five categories: demographic and socioeconomic, CPAP-related problem, upper airway-related problem, physiopathology and beliefs about health. A multivariate logistic regression was used to identify significant causes of non-adherence to CPAP therapy. A two-tailed P value lower than 0.05 was considered significant. RESULTS: 75 patients (83.3%) were considered to be adherent and 15 (16.7%) as non-adherent. Three criteria were significant for adherence to CPAP (OR ; CI 95%) : 1) being aware of the risk of complications if not using CPAP (2.54 ; 1.364.75) ; 2) being aware that CPAP treatment is effective (3.19 ; 1.2-8.46) ; 3) feeling of being less sleepy during the day after starting CPAP therapy (1.74 ; 1.2-2.52). One criteria was significant for non-adherence to CPAP: feeling of breathlessness with the CPAP mask (0.42 ; 0.25-0.72) CONCLUSIONS: Our study corroborates already published data but highlights previously unidentified factors of compliance. Although our two groups are not fully matched, our results clearly isolate 4 criteria that every anesthesiologist should seek during the preoperative visit. Our results must be confirmed by a study on a larger scale. CLINICAL IMPLICATIONS: Our study would allow detecting more efficiently non-adherent patient to CPAP therapy. Isolating insufficiently treated OSA patients with increased postoperative risk would allow better orienting toward inor outpatient surgery management. DISCLOSURE: The following authors have nothing to disclose: Eric Deflandre, Stephanie Degey, Vincent Bonhomme, AnneFrancoise Donneau, Robert Poirrier, Jean-Francois Brichant, Pol Hans No Product/Research Disclosure Information Copyright © 2014 American College of Chest Physicians