Impact of an early follow-up visit on adherence and adherence trajectories after initiation of continuous positive airway pressure therapy for obstructive sleep apnea.

INTRODUCTION AND

OBJECTIVE

Continuous positive airway pressure (CPAP) outcomes depends on adherence, yet the effect of different patient support strategies on adherence is poorly studied. This study assessed whether an early home visit improves CPAP adherence and trajectories in obstructive sleep apnoea, and which patients benefit most.

MATERIAL AND

METHODS

This multicenter cohort study analysed home service provider data from adults starting CPAP in 2019-2022 who had >90 days of telemonitoring data. Adherence was compared before and after the early visit, overall and in subgroups based on adherence over the 15 days after starting CPAP (<2 [low], 2-<4 [intermediate] or ≥4 [high] h/night). Adherence trajectories were also determined.

RESULTS

A total of 4,924 patients were included (62.3% male, mean age 59 ± 13 years, apnoea-hypopnoea index 40 ± 17/h). The early follow-up visit took place 16 ± 5 days after CPAP initiation. Change in adherence in the week after versus week before the early visit was 14 ± 3 min/night overall, and -7 ± 2, 60 ± 4, 102 ± 5 min/night in the high, intermediate, and low adherence subgroups, respectively (p < 0.01). Adherence gradually decreased after therapy initiation, increased in the 1-2 days before the visit, then declined. Cluster analysis identified two profiles across all early adherence subgroups: responders and non-responders (those with or without better CPAP usage after the early visit, respectively). Responders were slightly older and had higher CPAP motivation than non-responders; higher leak and higher residual AHI predicted improved adherence after the early visit in the intermediate and low adherence subgroups, respectively.

CONCLUSIONS

An early home visit intervention significantly improved short-term adherence for low and intermediate CPAP adherers. Cluster analysis revealed two distinct adherence trajectories supporting the need for personalised follow-up.