At-home versus in-hospital initiation of non-invasive ventilation in obstructive sleep apnea patients

ABSTRACT

Introduction: The COVID-19 pandemic led to the development of numerous adaptations in the healthcare systems in order to minimize the risk of infection for patients and healthcare professionals. One of the main difficulties related to Sleep-related breathing disorders, namely Obstructive Sleep Apnea (OSA), was the initiation of noninvasive ventilation (NIV), as this procedure carries a high risk of transmission through aerosol generation. In our hospital, patients previously initiated NIV at the Sleep Disorders Clinic. However, due to the pandemic, this had to be suspended and NIV initiation began to take place at the patient's home. Our objective was to evaluate the difference in adherence to NIV when this therapy was initiated in-hospital or at home. Method(s) Retrospective study, evaluating the differences in NIV adherence between patients with OSA that initiated NIV in-hospital (previously to the pandemic) or at home (post-pandemic). Statistical analysis was performed using an independent samples t-test on SPSS Statistics version 27. Result(s) From the patients that had OSA diagnosed through polysomnography level 3, we selected 114, of which 60 initiated NIV inhospital and 54 initiated NIV at home. In both groups, the majority of patients were male (76,7% in the inhospital NIV initiation group and 70,4% in the home NIV initiation group), with a mean age of 60,9 +/- 10,4 years and 61,3 +/- 10,6 years, respectively. Most patients had severe OSAS (78,3% and 75,9%, respectively) and had a body mass index (BMI) >= 30 (76,6% and 81,5%, respectively). In the first-month post NIV initiation, mean adherence was 88,3% in patients that had in-hospital initiation and 85,0% in patients with home NIV initiation. In the sixth month was 89,2% and 85,9%, respectively, and after 1 year was 96,7% and 82,50%, respectively. No statistical difference was found between adherence in all periods (p > 0,05). Conclusion(s) Our work suggests that home initiation of NIV in OSAS patients has non-inferior results in terms of patients' adherence and is a possibility to maintain in the future. This will allow reallocation of human resources to other areas in Sleep Disorders that are understaffed.