0570 Impact of a Sleep Apnea Management Group Clinic on PAP Adherence and PROs: A Randomized Controlled Trial

Abstract Introduction Positive airway pressure (PAP) is the mainstay treatment for obstructive sleep apnea (OSA), yet suboptimal adherence limits treatment effectiveness. We examined the impact of a sleep apnea management (SAM) clinic, an innovative, interactive group clinic which provides interpersonal support to patients and allows access to resources and education, on PAP adherence and patient reported outcomes (PROs) compared to usual care. Methods Participants with OSA and newly prescribed PAP therapy and sub-optimally adherent (CMS criteria) during the first two weeks, were randomized to SAM clinic(n=26) versus usual care(n=30) from April 2019 to November 2022 (NCT-03835702). The primary outcome was change in average daily PAP usage, whereas secondary outcomes were changes in Epworth Sleepiness Scale (ESS), Patient Health Questionnaire-9 (PHQ-9), and PROMIS scales from baseline to 1 and 3 months. Baseline adjusted mixed effect linear and logistic models estimated between and within groups differences. Results A total of 56 participants were enrolled with a mean age of 55 years, 57% female, 63% Caucasian, median AHI of 22.8 (9.3,39.6), and median baseline PAP usage of 172 minutes. After 3 months, the mean (95% CI) SAM clinic daily PAP use was 193(139, 247) minutes vs usual care at 148(110, 185) minutes with mean difference of 46(-8, 99) minutes per day (p=0.093). Within each group, a mean daily difference of 11(-36,57) minutes (p=0.65) in SAM clinic and -32(-75,12) (p=0.15) in the usual care was observed. No significant differences were observed in PROs between SAM and usual care. Within each group, ESS change was -0.7(-2.5,1.2) (p=0.48) in SAM clinic and -2.5(-4.2, -0.83) (p=.004) in usual care. Significant decrease was noted in PHQ-9 within both SAM clinic at-2.2(-3.9, -0.4) (p=0.019) and in usual care at -2.3(-4.0, -0.7) (p=0.006). Improvement in PROMIS sleep related impairment was noted within both groups: SAM clinic at -3.0(-6.2,0.1) (p=0.059) and usual care group at -3.5(-6.4, -0.60) (p=0.019). Similar changes in PAP adherence and PROS were seen at the 1-month follow-up. Conclusion SAM clinic may improve PAP adherence and some PROs better than usual care; however future studies are needed to confirm findings as this trial was underpowered due to premature termination resulting from the pandemic. Support (if any)