Compliance and adherence to continuous positive airway pressure (cpap) during covid pandemic

ABSTRACT

Introduction Continuous positive airway pressure (CPAP) is currently the treatment of choice for patients with obstructive sleep apnea (OSA);however, adherence is often thought to be suboptimal, especially in patients with anxiety. Due to the 2019 novel coronavirus disease (COVID-19) outbreak, it was suggested that difficulties in accessing the healthcare system and the anxiety produced by the situation could have a negative impact on adherence to treatment. The main objective of the study was to compare compliance and adherence of patients in a home CPAP monitoring program before and during the pandemic. Methods Patients diagnosed with OSA treated with CPAP participating in a telemonitoring program were included in the study. The pre-pandemic period was March to August 2019. Using data collected from the Ohio Department of Health, we identified two peaks in 2020. The pre-peak period was defined as March 1st to April 15th;the 1st peak as April 16th to July 12th, and the 2nd peak as July 13th to August 31st. Study variables included the mean hourly usage over each time period and the number of patients identified as low adherers, which was defined as a mean CPAP usage of less than 10 minutes. CPAP compliance was analyzed using repeated measures ANOVA. CPAP adherence was analyzed using Cochran's Q test with post-hoc testing using McNemar's tests to determine group differences. Results The study sample consisted of 418 patients using CPAP, which were measured multiple times throughout the study period. Patient compliance and adherence are summarized in Table 1. There was not a statistically significant effect of time on CPAP compliance over the four time periods, F (3, 1251) = 0.747, p = 0.524. There was a statistically significant difference in the proportion of CPAP users with low adherence, χ2 (3) = 16.69, p = 0.001. Subsequently, post-hoc testing revealed there were statistically significant differences in the proportion of low adherence CPAP users in 2019 compared to the pre-peak, 1st peak, and 2nd peak periods. Conclusion Recent studies in Europe and New York City have indicated CPAP compliance and adherence was not adversely affected during the COVID-19 lockdowns. While our study found mean CPAP compliance above 6 hours across the study periods, there were a significant proportion of low CPAP adherers during the pre-peak and peak periods during the pandemic. The reasons for low adherence should be ascertained by a follow-up study.