0628 A Behavioral Intervention to Address PAP Nonadherence in Middle-Aged and Older Veterans with Obstructive Sleep Apnea: A Randomized Controlled Trial

Introduction Nearly half of patients with obstructive sleep apnea (OSA) who begin positive airway pressure (PAP) therapy discontinue use within a year. While behavioral interventions improve initial PAP use, less evidence exists on addressing longstanding insufficient PAP use. Methods A randomized controlled trial tested the efficacy of a manual-based behavioral treatment (provided by a non-clinician sleep coach, supervised by a behavioral sleep medicine specialist) to address insufficient PAP use among middle-aged and older adults with OSA (apnea-hypopnea index >15) prescribed PAP therapy 1-5 years prior who were nonadherent (< 90 out of 180 days of PAP use and no use over the past 30 days). Participants received a new PAP device if needed and were randomized to either intervention or a control sleep education program (both groups received 5 weekly sessions and monthly telephone calls for 6 months). Primary outcomes: mean hours of PAP use per night via remote monitoring over days 1-180 (T1, primary) and 181-365 (T2, secondary) post-randomization. Independent groups t-tests compared PAP use between groups. Secondary outcomes: nights PAP used >4 hours and Epworth Sleepiness Scale (ESS) at baseline, 6- and 12-months post-randomization. Results Among 106 participants (n=53 per group) aged 51-90 (mean=66.3±9.4 years, 88.7% males), intervention participants averaged 1.3 more hours of PAP usage per night than controls during T1 (2.2 versus 0.9 hours/night, p< 0.001, 95% CI=0.6, 1.9), and 1.1 more hours per night during T2 (1.6 versus 0.4 hours/night, p< 0.001, 95% CI=0.5, 1.7). Intervention participants used PAP for >4 hours on 30.1 more nights versus controls (51.2 versus 21.1 nights, p< 0.001, 95% CI=13.4, 46.8) during T1 and 26.2 more nights during T2 (37.1 versus 10.9 nights, p< 0.001, 95% CI=11.0, 41.3). Intervention participants also showed significant ESS reductions (p< 0.001) from 9.5 at baseline to 6.1 at 6-month and 6.8 at 12-month follow-ups. Controls had no significant reduction in ESS (8.3 at baseline to 7.6 at 6-months and 8.0 at 12-months). Conclusion These findings suggest that behavioral interventions can improve PAP use and decrease daytime sleepiness (a hallmark symptom of untreated OSA) among middle-aged and older Veterans with long-term PAP adherence difficulty. Support (if any) VA/HSR IIR-20-046; NIH/NHLBI K23HL157754