An Official American Thoracic Society Statement: Continuous Positive Airway Pressure Adherence Tracking Systems. The Optimal Monitoring Strategies and Outcome Measures in Adults

Abstract

Background: Continuous positive airway pressure (CPAP) is considered the treatment of choice for obstructive sleep apnea (OSA), and studies have shown that there is a correlation between patient adherence and treatment outcomes. Newer CPAP machines can track adherence, hours of use, mask leak, and residual apnea-hypopnea index (AHI). Such data provide a strong platform to examine OSA outcomes in a chronic disease management model. However, there are no standards for capturing CPAP adherence data, scoring flow signals, or measuring mask leak, or for how clinicians should use these data. Methods: American Thoracic Society (ATS) committee members were invited, based on their expertise in OSA and CPAP monitoring. Their conclusions were based on both empirical evidence identified by a comprehensive literature review and clinical experience. Results: CPAP usage can be reliably determined from CPAP tracking systems, but the residual events (apnea/hypopnea) and leak data are not as easy to interpret as CPAP usage and the definitions of these parameters differ among CPAP manufacturers. Nonetheless, ends of the spectrum (very high or low values for residual events or mask leak) appear to be clinically meaningful. Conclusions: Providers need to understand how to interpret CPAP adherence tracking data. CPAP tracking systems are able to reliably track CPAP adherence. Nomenclature on the CPAP adherence tracking reports needs to be standardized between manufacturers and AHI Flow should be used to describe residual events. Studies should be performed examining the usefulness of the CPAP tracking systems and how these systems affect OSA outcomes.Keywords: CPAP adherence; sleep apnea; CPAP tracking systems EXECUTIVE SUMMARYObstructive sleep apnea (OSA) is an extremely common condition and is associated with significant morbidity and mortality (1-18). Optimal treatment of sleep apnea is critical because sleepdisordered breathing is associated with the increased risk of vehicular crashes and cardiovascular morbidity and mortality (6, 9-18). Continuous positive airway pressure (CPAP) is the treatment of choice for sleep apnea (19)(20)(21)(22). Increased CPAP adherence has been shown to improve outcomes such as daytime sleepiness, quality of life, and mortality (23-25). OSA should be considered in a chronic disease management model in which CPAP adherence is tracked over time. To assess CPAP adherence and efficacy, tracking systems have been implemented. Such systems monitor CPAP efficacy (residual sleep-disordered breathing), hours of CPAP use, mask leak, and a number of different flow signals. However, there are no standards on how to use the data from these new CPAP tracking systems nor do we have evidence that these systems ultimately improve outcomes. See the online supplement for full discussion of the literature on the accuracy of the residual AHI and mask leak.The purpose of this document is to (1) review the data (adherence, leak, efficacy, flow signals) obtained from CPAP adherence tracking systems and the reliability of th...

Residual Events during Use of CPAP: Prevalence, Predictors, and Detection Accuracy

“…2 As such, those patients in whom this data is likely to be of added benefit, to assess control, and determine the need for treatment parameter adjustments, need to be identified. One such group, as shown in this study, is that with high central apnea index on the baseline study.…”

“…1 Continuous positive airway pressure (CPAP) is the treatment of choice. 2 Modern positive airway pressure (PAP) devices measure and store airflow and pressure data, displaying the latter as residual event and compliance indices. 3 This allows for tracking of both efficacy and adherence.…”

“…3 This allows for tracking of both efficacy and adherence. 2 However, vendor algorithms vary, and there are no specific guidelines or standards for capturing, measuring, or scoring the data.…”

Adherence and Subthreshold Adherence in Sleep Apnea Subjects Receiving Positive Airway Pressure Therapy: A Retrospective Study Evaluating Differences in Adherence Versus Use

“…1 In the United States 2 and internationally, [3][4][5] either on the Medicare policy of 4 h/night for 70% of nights/week or variations thereof. 2,[6][7][8] Although such policies manifest great influence over clinical care, they are based only on descriptive studies (Level V: lowest-rated evidence on Sackett's criteria 9 ) in lieu of rigorous scientific investigations.…”

Cpap-Therapy Decreases Glycated Hemoglobin in Patients With Type 2 Diabetes Mellitus and Sleep Apnoea

“…Контроль приверженности проводился через 3 месяца после начала терапии собственным аппаратом, одновременно с забором анализов для оценки углеводного и липидно-го обмена в динамике. Пациенты с низким уровнем при-верженности, по рекомендациям American Thoracic Society, не включались в анализ [11]. Описанная схема взаимодействия с пациентом и разработанная нами система учета в виде автоматизированной таблицы MS Excel позволила при проведении ретроспективного исследования оперировать достаточным количеством медицинских данных.…”