705 PAP Use Pattern Change During the COVID-19 Lockdown

Abstract

Introduction The COVID-19 pandemic has greatly impacted not only the physical health of society, but also its social, mental, and economic health. The Illinois shelter in place orders enacted in March and April limited work and activities outside the home. Our aim for this study was to compare the effects of the COVID-19 shelter in place orders on PAP use patterns in patients with OSA. Methods We selected 30 patients seen between May and October 2020. Patients had been diagnosed with OSA for at least one year, prescribed PAP therapy and had been compliant with therapy as defined by 70% use greater 4-hour for 30 days prior to their clinic visit. Using data collected from chart review as well as online ResMed AirView cloud data, we evaluated PAP on/off and average use time during shelter in place order for a 90 day period (March through May 2020). We compared this data to a similar period in the year prior. Results Average age of our study group was 58.6 years old with 19 men and 11 women. Mean AHI was 51.7. Reported average bedtime was 10:00pm with average wake time 7:30am during the shutdown compared with a bedtime of 9pm and wake up time 6:30am. Patients reported having more time to sleep and required less naps during the day. Average PAP use during shut down was 7 hours 20 minutes and average PAP use prior to shutdown was 6 hours and 50 minutes. An average of 30 additional PAP minutes was observed among patients during the shelter in place order. Only one of our patients was diagnosed with COVID during this time period. Conclusion For patients with OSA on PAP therapy we observed an increase in PAP use. Among patients suddenly required to shelter in place, we observed a delayed sleep onset and wake time of more than 1 hour, resulting in a slightly longer overall PAP use time. This circadian phase shift was greater among working patients compared to retired patients. The health effects of longer PAP use and circadian phase shifting remain to be determined. Support (if any):

Impact of the COVID-19 pandemic on adherence to positive airway pressure treatment in patients with obstructive sleep apnea: systematic review and meta-analysis

“…We screened 225 articles and identified 13 potentially eligible articles ( Figure 2 ). After full-text review, 10 observational before-and-after studies 8 – 17 met our inclusion criteria. No relevant randomized controlled trials were found.…”

“…This finding differed from those of studies in Western countries that implemented national lockdowns. 8 – 13 Pépin et al reported that PAP adherence significantly increased from 6.45 h/day to 6.90 h/day after the first national lockdown in France. 9 A similar finding was observed after the lockdown in Spain.…”

“…Studies have reported that PAP adherence significantly increased after lockdowns in France, 8 – 10 Spain, 11 Croatia, 12 and the state of Illinois in the United States. 13 In contrast, research conducted in Turkey 14 showed a decrease in adherence, whereas no difference was reported in studies in the US state of Massachusetts, 15 Thailand, 16 and Poland. 17 …”

“…Studies have reported that PAP adherence significantly increased after lockdowns in France, [8][9][10] Spain, 11 Croatia, 12 and the state of Illinois in the United States. 13 In contrast, research conducted in Turkey 14 showed a decrease in adherence, whereas no difference was reported in studies in the US state of Massachusetts, 15 Thailand, 16 and Poland. 17 Instead of enforcing a national lockdown -the strictest enforcement of physical distancing and one that was frequently implemented by Western countries -the Korean government enacted social distancing on 22 March 2020 to control COVID-19 transmission.…”

“…[8][9][10][11][12][13] Figure 1. Changes in average daily PAP usage in hours before and during the COVID-19 pandemic.PAP, positive airway pressure.…”