What question did this study set out to answer?

To assess long-term CPAP use among patients who did not meet the CMS 90-day adherence requirement, evaluating implications for treatment abandonment.

May 20, 2026

D97-06 Reevaluating the Centers for Medicare and Medicaid Services 90-Day Cpap Adherence Requirement: Persistent Use Among Early Nonadherent Patients

Key Points

To assess long-term CPAP use among patients who did not meet the CMS 90-day adherence requirement, evaluating implications for treatment abandonment.
Analyzed adults with obstructive sleep apnea dispensed CPAP from 2020-2023 within Kaiser Permanente Southern California.
Stratified patients based on CMS adherence status and measured CPAP use at one year post-initiation, including nightly minutes and the percentage of nights ≥4 hours.
49.0% of all patients met 90-day CMS adherence; 36% of non-adherent patients still used CPAP at Month 12.
Mean usage among non-adherent patients was 197±160 minutes per night, with 42.9±36.0% of nights ≥4 hours.
Among non-adherent patients ≥65 years, 23.3% used CPAP ≥2 hours/night, and 16.5% maintained use ≥4 hours/night.

Abstract

Abstract Rationale In 2009, the Centers for Medicare 65.5% male; mean AHI4% 32.5±25.0), 49.0% met 90-day CMS adherence, increasing to 53.5% in those ≥65 years of age. Failure to meet CMS adherence was associated with younger age, female sex, non-White race/ethnicity, lower socioeconomic status, and less OSA severity. At Month 12 (Table), 36% of patients not meeting CMS adherence still used CPAP. In this group, mean use was 197±160 min/night, with 42.9±36.0% of nights ≥4 hours. Overall, of all CMS non-adherent patients, 20.9% used CPAP ≥2 h/night and 13.6% ≥4 h/night during Month 12; among those ≥65 years of age, Month 12 usage was even greater at 23.3% ≥2 h/night and 16.5% ≥4 h/night. Conclusions Over one-third of patients not meeting the CMS 90-day adherence requirement continued CPAP use at one year with average usage at levels associated with symptomatic benefit. These results challenge the assumption that early non-adherence predicts treatment abandonment, and they support redefining CPAP success based on patient-centered outcomes rather than fixed usage thresholds. This abstract is funded by: American Academy of Sleep Medicine Foundation Strategic Research Award 205-SR-19

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