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Background CPAP is an established first-line treatment for moderate-to-severe OSA. Adherence is universally low and is predicted by short-term adherence. Moderate-to-severe OSA is strongly associated with adverse cardiovascular outcomes. Evidence of CPAP benefit is limited to underpowered subgroups with arbitrarily defined "good adherence". Covid-19 has generated widespread acceptance and uptake of telemedicine. This study aims to determine if CPAP adherence is affected when health service is provided by telemedicine rather than in-person. Methods Single-centre, retrospective, cohort study of moderate-to-severe OSA patients identified between 1/6/21 and 30/6/22. Medical records were reviewed for residential address, referral pathway (face-to-face or telemedicine), age, gender, BMI, ESS, AHI and AI. Short-term adherence was determined from CPAP downloads. Progress to date 368 patients were identified, 40% had moderate-to-severe OSA. 31.5% were reviewed by telemedicine (64% remote, 36% local). Compared to in-person, remote telemedicine cohort was similar age (age ≥ 50, 64.9% vs 53.2%, p= 0.075) but more likely male (66.2% vs 50%, p= 0.014). ESS (9.7 ± 1.4 vs 9.1 ± 0.7, p= 0.38), BMI (36.1 ± 2.5 vs 33.5 ± 1.3, p= 0.08), AHI (27.5 ± 7.5 vs 21.7 ± 3.4, p= 0.12) and presence of moderate-to-severe OSA (48.6% vs 42.5%, p= 0.35) were similar. Patient subgroups including local, remote, telemedicine and face-to-face reviews were analysed. Adherence data is pending. Intended outcome and impact Pilot telemedicine programs (e.g. TeleSleep) are developing services designed to provide accessible and efficient care to remote patients. $800 per patient, environmental and transport savings can be anticipated.

Introduction Patient non-attendance at outpatient sleep clinics is common and costly. Little is known about the factors associated with sleep clinic non-attendance, especially in an Australian context. The goal of our audit was to identify the patient, referral, and appointment factors that may affect attendance at an outpatient sleep clinic. Methods A case-control study was performed in 171 patients (57 cases / non-attenders and 114 controls / attenders) who had a sleep clinic appointment between September 20th, 2020 and March 21st, 2021. Statistical analysis was performed using the two-sided chi-square test with a 5% significance level. Results The overall rate of non-attendance was 10.8%. The rates of non-attendance between new and review cases were similar. Being single (odds ratio [OR]: 2.49; p = 0.010), middle-aged (OR: 4.39; p < 0.001 vs. older-aged), or female (OR: 2.08; p = 0.026) was associated with a higher rate of non-attendance. English was the primary language for all non-attenders. A higher proportion of non-attenders than attenders were born in Australia. For new cases, the source of referral, reason for referral, and triage category did not affect attendance rates. Likewise, the patient’s primary sleep disorder and treatment status did not affect attendance for review cases. Conclusion Factors associated with non-attendance at an outpatient sleep clinic include being single, middle-aged, or female. By identifying patients at higher risk of clinic non-attendance, a more tailored approach can be developed to mitigate this issue.