C30-12 Sex Differences in CPAP Adherence Across 2 Years: Evaluating the Contribution of Insomnia Diagnosis

Abstract Rationale Women at all ages are less adherent to continuous positive airway pressure (CPAP) than men in the first 90 days post initiation but less is known about sex differences in their adherence patterns over 24 months. Women have higher rates of insomnia at OSA diagnosis than men suggesting a possible reason for this disparity. Our goal was to examine sex differences in CPAP adherence patterns over 24 months and explore whether comorbid insomnia was associated with these patterns. Methods This retrospective clinical cohort represents individuals with a diagnosis of OSA (apnea-hypopnea index (AHI) ≥ 5 events/h) obtained from a diagnostic sleep study (home sleep studies or polysomnography) performed at a clinical sleep center in PA from 2015-2022. Evidence for insomnia was based on electronic health record (EHR) diagnosis codes ascertained at the time of the sleep study. Daily CPAP adherence, also collected from the EHR, was collected over 24 months and summarized in 3- to 6-month intervals. Associations between sex, insomnia diagnosis and CPAP adherence were assessed using general linear models. Results A total of 3,328 women and 4,396 men with a diagnosis of OSA and new CPAP order were included. Approximately half of all men (50.4%) and women (50.2%) had daily CPAP data available in the EHR. Women had less severe OSA (mean AHI 23.1+/-23.6) than men (mean AHI 34.4+/-28.9). Women had a higher rate of insomnia (20.5%, n = 1,273) compared to men (14.0%, n = 820; p .001). Women were less adherent to CPAP than men at 3 months (mean usage: 3.96 vs. 4.34 hours/night; p .01); and at 18-24 months (4.15 vs. 4.62 hours/night; p .01). At 0-3 months, women without insomnia were less adherent than men with insomnia (β = −0.46 h/night, SE = 0.16, p = .02). Among men and women without insomnia, women used CPAP less than men (β = −0.43 h/night, SE = 0.09, p .01); in those with insomnia, women showed a nonsignificant trend toward reduced adherence (β = −0.50 h/night, SE = 0.20, p = .06). There were no significant differences in adherence in women with and without insomnia and in men with and without insomnia (all p values .05). Conclusion Women are less adherent to CPAP than men over the first 2 years of treatment. Sex is an important predictor of CPAP adherence independent of insomnia diagnosis. This abstract is funded by: AHA 20CDA35310360; Penn Program Project grant number: P01HL160471; NHLBI:1R01HL170675-01A1I(Morris/Mazzotti)