The effect of a change from face-to-face to remote positive airway pressure education for patients with sleep apnoea during the coronavirus disease-2019 pandemic: a prospective cohort study

Abstract

Background: The coronavirus disease-2019 (COVID-19) pandemic and national lockdowns necessitated a change in service delivery including positive airway pressure (PAP) education protocols, with no data on how this may impact subsequent PAP adherence. We aim to quantify adherence of PAP initiated during the COVID-19 pandemic and compare the effects of remote versus face-to-face (FTF) education in patients with obstructive sleep apnoea (OSA). Methods: This prospective cohort study in a tertiary National Health Service (NHS) hospital sleep disorders centre in London, United Kingdom, included 141 patients aged >18 years with newly diagnosed OSA initiating PAP during the COVID-19 pandemic; 71 patients receiving standard FTF education compared to 70 patients educated on PAP remotely at the start of lockdown.Results: Adherence over a consecutive 30-day period within the first three months of PAP usage was measured, secondary outcomes included average nightly usage, usage per nights used, percentage of nights used, and percentage of nights used for ≥4 hours. In 141 patients (two-thirds male, 56% of at least 45 years of age and 48.9% sleepy at baseline), 114 patients (81%) were diagnosed with moderate or severe OSA.54 patients (38.3%) achieved good adherence (≥70% of nights with ≥4 hours usage), with an average of 4.7 hours of PAP usage per night used. Patients receiving FTF PAP education had a comparable level of good adherence (38% versus 38.6%, P=0.915), and hours per nights used (4.7 versus 4.6 h/night, P=0.711) to remotely educated patients. More severe OSA, lower mask leak, and a nasal mask were associated with achieving good PAP adherence.Conclusions: PAP adherence of newly diagnosed individuals with OSA during the COVID-19 pandemic was modest at 38.30%, and not significantly affected by remote PAP education delivery.

Long-Term Adherence to Continuous Positive Airway Pressure in Patients with Obstructive Sleep Apnoea Set Up in a Complete Remote Pathway: A Single-Centre Service Evaluation Project

“…A tertiary sleep service in the UK evaluated adherence to CPAP at 90 days in patients who were set up remotely and compared them to patients similarly set up during the COVID-19 pandemic but in a face-to-face setting. The adherence to CPAP at 90 days was comparable to our data (39% vs. 41%) [9]. Of note, patients in the face-to-face group had less severe OSA [9], which could be a potential bias, as our project has concluded that disease severity was associated with long-term adherence for patients in the remote pathway.…”

“…The adherence to CPAP at 90 days was comparable to our data (39% vs. 41%) [9]. Of note, patients in the face-to-face group had less severe OSA [9], which could be a potential bias, as our project has concluded that disease severity was associated with long-term adherence for patients in the remote pathway. A study in the United States compared patients who were set up either face-to-face or remotely; the latter group was divided into patients who received CPAP before and during the pandemic.…”

“…Taking into consideration that these opportunities are not available during remote setups, it may be expected that the short-and long-term adherence to CPAP during remote setup are inferior to face-to-face set up. Whilst a recent study has concluded this is not the case in the short term [9], to our knowledge, this is the first project evaluating the long-term adherence to CPAP in patients who were set up on a fully remote pathway.…”

“…Nevertheless, our service has successfully adopted a fully remote diagnostic and CPAP service, where patients did not have any direct physical encounter with the service [8]. The adherence to CPAP (defined as at least 4 h of usage on at least 70% of the days) at 90 days was 41%, which was comparable to other tertiary services in the United Kingdom [6,9] and was similar to what was achieved in randomised controlled trials [10]. Whilst transformation to remote diagnostic and treatment services was necessary during the first waves of the pandemic, it was unclear if the level of adherence could be maintained in the long term.…”

“…There are only a limited number of studies that our results can be compared with [9,13,14]. A tertiary sleep service in the UK evaluated adherence to CPAP at 90 days in patients who were set up remotely and compared them to patients similarly set up during the COVID-19 pandemic but in a face-to-face setting.…”