0613 Higher Patient Satisfaction and Therapy Adherence with CPAP vs. ACPAP: Experience in Practice

Introduction Positive airway pressure (PAP) is the standard for treating obstructive sleep apnea (OSA). However, clinical practice varies regarding initiation strategies: sleep-lab titration followed by fixed continuous PAP (CPAP) vs. auto-CPAP. These secondary analyses expand earlier work examining associations between PAP modality, patient therapy satisfaction (PTS), and initial PAP adherence. Methods This cross-sectional study examined initial adherence/therapy data from two Southeast Michigan durable medical equipment companies for new PAP users (ages ≥ 18) treated for OSA between 01/2022-12/2022. Logistic regression adjusted for age, gender, body mass index (BMI), health insurance, diagnostic testing, median and 95th percentile pressures, diagnostic apnea-hypopnea index (AHI), and propensity scores (calculated using all mentioned variables except pressures settings) was used to examine associations between PAP modality, and PTS (first-month care check-in) and PAP adherence (usage ≥4h for ≥70% of 30 days). Similarly-adjusted linear regression with propensity weighting was used to examine associations between PAP modality and total days PAP used, percent days PAP used ≥4h, and average usage hours (total days, days used, and total hours). Results Among 482 subjects, 50.4% were female. Mean age was 51.9±15.8 years. Median BMI was 33.8±9.0 kg/m2. Compared to auto-CPAP (n=281), CPAP users (n=201) were older (53.6±16.3 vs. 50.6±15.3 years), diagnosed mostly via in-lab polysomnography (70.6% vs. 56.6%), had higher AHI (median 18.0±27.0 vs 11.4±14.1), median leaks (3.2±7.5 vs 1.5±4.6 L/min), and median pressure (9.5±3.4 vs. 7.5±2.1 cmH2O, each p< 0.05). The PTS among CPAP users was 80.1% vs. 67.7% (p=0.02). Adjusted analysis showed associations between PAP modality and PTS (OR=2.2, 95% CI [1.2, 4.0, p=0.01]), and CPAP adherence (OR=2.1, 95% CI [1.1, 3.9, p=0.02]). Adjusted linear regression showed CPAP-treated patients had increased days used (β=11.4, 95% CI [3.7, 19.1] days), percent days with ≥4 h (β=10.6, 95% CI [1.7, 19.5] %), PAP use hours on total days (β=0.7, 95% CI [0.1, 1.4] h), hours on days used (β=0.8, 95% CI [0.2, 1.3] h), and total hours (β=70.6, 95% CI [9.2, 132.0] h). Conclusion This analysis from a quasi-experimental design using real-world data suggests higher patient satisfaction and adherence—by about 120% and 110%, respectively—after titration studies and CPAP use compared with auto-CPAP use. Support (if any)