P53 CPAP supply challenges to UK Sleep centres in 2022

BackgroundContinuous Positive Airway Pressure (CPAP) therapy is the standard treatment for patients with Obstructive Sleep Apnoea (OSA). Significant recent challenges have affected CPAP supply worldwide: increased CPAP demand, interrupted logistics during the COVID pandemic, worldwide Field Safety Notice (2021), plus CPAP component shortages.MethodsTo understand the issues around CPAP delivery and supply, the OSA Alliance sent an email survey to all UK-based Sleep Centres listed on the Sleep Apnoea Trust database in February and again in June 2022.ResultsWe received replies from 22 (February) and 15 (June) UK centres, with 8 centres represented in both surveys.91% (February) and 67% (June) of respondents confirmed ongoing CPAP machine supply shortages. In February, centres were receiving on average 50% usual delivery versus 73% in June. In June, centres described CPAP supply during the past 6 months as: improved 47%, worsened 47%, same in 6%. In free text comments, humidifier shortage was also mentioned by some.Patients on the waiting list for CPAP varied between UK centres from 0–400 (February) and 0–260 (June). All centres with CPAP shortages were using the BTS Clinical Risk Stratification.1In February, patients with high clinical priority according to the risk stratification requiring urgent CPAP therapy could start this quickly (1–2 weeks) in all centres, but the average wait time to start routine CPAP was 13 weeks (range 2 to 40 weeks). In June, the average wait for routine CPAP was 13.3 weeks (range 2–52 weeks). In both surveys, the majority of centres (86% February and 67% June) said delays were due to CPAP supply, not staff shortages.ConclusionsOngoing CPAP supply issues have led to self-reported sleep centre delays in treatment for patients with OSA. CPAP supply appears highly variable between centres, meaning centres have searched for alternative suppliers;a time consuming task with teams not being trained on the respective CPAP models. A humidifier shortage contributes to difficulties that may impact on CPAP adherence. Specific resource allocation towards CPAP provision for patients with OSA is required to address these issues and improve compliance NICE evidence-based therapeutic guidance in the UK.The authors have produced this abstract on behalf of the OSA Alliance, UK.Referencehttps://www.brit-thoracic.org.uk/news/2021/national-patient-safety-alert/

A novel classification of obstructive sleep apnoea enabling precision medicine to improve adherence to continuous positive airway pressure: A growth mixture modelling analysis

Introduction: High non-adherence rates to CPAP remain a major obstacle to good outcomes in OSA. In trials, 29%-83% of patients do not adhere to CPAP. CPAP adherence in clinical practice, and the effect of clinical pathways and interventions, remain unknown because of incomplete datasets and use of non-clinically relevant criteria for adherence in previous studies. Patients are reported to become adherent or non-adherent to CPAP from treatment onset, forming the basis of current clinical practice, but the studies have been small. We addressed these evidence gaps using a large, UK multicentre clinical dataset, using changes to sleep centres' treatment pathways during the COVID-19 pandemic as a natural experiment. Method(s): Five sleep centres that telemonitored patient data in 2019 and 2020 were recruited. Using a 18% difference in CPAP adherence between years (Philips Respironics data), 80% power, alpha < 0.05, n = 92 was required. Objective CPAP-usage data over the first three months of treatment was collected from 100 patients who started CPAP prepandemic (April 2019) and 100 patients post-start of pandemic (September 2020), per centre. CPAP adherence criteria: Mean CPAP use >=4 h/night for >=70% of nights (for Night 1-3 period, median CPAP use used, as data non-normally distributed). Growth mixture modelling (GMM) and logistic regression were performed using all centres' data (1000 patients). Result(s): Three months after treatment started, only 34% of patients were treatment-adherent in 2019 and 42% in 2020 (p = 0.24). GMM identified six distinct, CPAP-usage behaviours over the first month, each with a different likelihood of CPAP non-adherence at three months. Four behaviours consisted of changing (increasing or decreasing) CPAP use (54% of patients), two behaviours consisted of consistent good or no use (remaining 46%). Treatment pathway determined prevalence of behaviours and CPAP adherence at three months;OSA severity was a weaker determinant of CPAP adherence at three months. Conclusion(s): CPAP use at treatment onset does not predict long-term adherence in most patients. This can explain why current practice is ineffective, and may even be detrimental, as the changing users are inappropriately managed as consistent users . Our data supports precision medicine tailored to specific behaviour from Week 2 of treatment.

Mortality in patients requiring home mechanical ventilation during the COVID-19 pandemic: experiences of a regional specialist ventilation unit

P101 Figure 1(A) Monthly mortality of patients under Lane Fox Respiratory Service follow-up, dotted lines represent upper and lower bounds of 95% confidence intervals (B) Proportion of home mechanical ventilation (HMV) users in each disease category who died between 1st March and 30th ApriI by year[Figure omitted. See PDF]ConclusionsDeaths amongst HMV users at our regional ventilation centre were highest in the first two months following the onset of the COVID-19 pandemic. A subsequent fall in mortality may relate to effective shielding advice following national lockdown and departmental guidance offered. The majority of deaths were in patients with obesity-related respiratory failure. These data support previous observations that obesity is a major risk factor for adverse outcomes in patients with COVID-19.