Did COVID-19 impact Positive Airway Pressure adherence in 2020? A cross-sectional study of 8477 patients with sleep apnea

Abstract

Background Whether the COVID-19 pandemic impacts Positive Airway Pressure (PAP) adherence over the long-term is unknown and only preliminary short-term data have been reported. Methods With the aim of describing the impact of the first and second waves of COVID-19 on PAP adherence during 2020 in France, we designed a cross-sectional study of Sleep-Apnea (SA)-patients under PAP telemonitoring. To examine PAP adherence in adult SA patients, we assessed de-identified data from a non-profit healthcare provider database during the period January 1, 2019 to December 31, 2020. Included patients met the following criteria: (i) PAP-treated for at least 4 months before January 1, 2019 and with continuous PAP during both 2019 and 2020; (ii) ≥ 360 daily PAP telemonitored data per year. For PAP adherence, data were collected using the PAP-software. Results 8477/10482 patients were finally included in the analysis [72.4% male, median age 70 years (IQ25–75: 61–77], 25.6% < 62 years old, initial Apnea–Hypopnea Index (AHI) of 41 (31–59)/h. Median PAP adherence was 7.21 (6.12–8.10) h/day in 2020 versus 7.12 (6.05–8.02) h/day in 2019, p < 0.001. The median difference in PAP adherence between the first 2020 lockdown and the corresponding 2019 weeks was 9.75 (CI95% 8.75–10.75) min/day, p < 0.001. The median difference in PAP adherence between the second 2020 lockdown and the corresponding 2019 weeks was 5.00 (CI95% 4.00–6.00) min/day, p < 0.001. If we consider the minimal clinically important difference of 30 min for PAP adherence, 30.4% and 26% of the patients increased their PAP adherence by at least 30 min during the first and second lockdowns respectively; 17.6% and 19.3% of the patients lowered their PAP adherence by at least 30 min in the first and second lockdowns, respectively. Conclusion During the first and second lockdowns, the COVID-19 pandemic had a clinically irrelevant effect on PAP adherence for the study population. Future studies are needed to describe COVID-19 pandemic impact on PAP adherence not only for long-term PAP-treated SA patients but also for incident cases. Trial registration The COVADENE study was registered on March 1st, 2021 on ClinicalTrials.gov (Identifier: NCT04775966)

COVID-19-related changes in outpatient CPAP setup pathways for OSA are linked with decreased 30-day CPAP usage

“…To our knowledge, there have been no studies assessing the effect of the COVID-19 pandemic on CPAP usage in those newly commencing CPAP. Small increases in CPAP usage during COVID-19 lockdowns have been reported in established users 5 6. In contrast we found lower CPAP usage in patients newly started on CPAP after the first wave of the COVID-19 pandemic.…”

Impact of the COVID-19 pandemic on adherence to positive airway pressure treatment in patients with obstructive sleep apnea: systematic review and meta-analysis

“…We screened 225 articles and identified 13 potentially eligible articles ( Figure 2 ). After full-text review, 10 observational before-and-after studies 8 – 17 met our inclusion criteria. No relevant randomized controlled trials were found.…”

“… 7 However, how the COVID-19 pandemic impacts PAP adherence in patients with OSA is controversial. Studies have reported that PAP adherence significantly increased after lockdowns in France, 8 – 10 Spain, 11 Croatia, 12 and the state of Illinois in the United States. 13 In contrast, research conducted in Turkey 14 showed a decrease in adherence, whereas no difference was reported in studies in the US state of Massachusetts, 15 Thailand, 16 and Poland.…”

Quality of Life, Mental Health, and CPAP Compliance in Thai Patients with Obstructive Sleep Apnea during COVID-19 Pandemic

“…However, a study by Michalek-Zrabkowska et al reported that the COVID-19 pandemic had no significant impact on CPAP therapy parameters and adherence in OSA patients [ 22 ]. Additionally, a large study involving 8,477 OSA patients by Bertelli et al demonstrated that the COVID-19 pandemic had a clinically irrelevant effect on CPAP adherence for OSA treatment [ 23 ]. Our study showed that CPAP compliance was 50%, consistent with a study by Rotenberg et al, which demonstrated CPAP compliance around 60% in normal situations [ 24 ].…”