Compliance
What is Compliance?
Compliance in sleep medicine is defined, at a minimum, by successfully using a PAP (Positive Airway Pressure) device for an average of 4 hours a night for at least 70% of the nights. Studies show that somewhere between 29% and 83% of patients do not meet the criteria for compliance due to removing the CPAP early in the night and/or discontinuing use altogether.1 Patients’ perception of CPAP within the first week of using the machine will affect long term results of CPAP compliance.2
Why is Compliance Important?
Compliance monitoring is crucial to a patient’s success with CPAP and achieving better overall health. One study showed that a single night without CPAP therapy was associated with a return to pretreatment levels of daytime sleepiness and impaired vigilance.3
CPAP reduces healthcare expenditures associated with Obstructive Sleep Apnea Syndrome. In one study, researchers tracked healthcare expenditures of sleep apnea patients before and after diagnosis. Costs were much greater in the year prior to diagnosis ($372) than in the five years before diagnosis. Furthermore, costs decreased after diagnosis such that healthcare expenditures 2 ($281) and 5 ($358) years after diagnosis were less than the year prior to diagnosis. The authors concluded CPAP therapy reduced healthcare expenditures and is sustained for at least 5 years.4
Benefits of Compliance
The benefits of CPAP can be felt the first night after treatment. Education about the equipment and the severity of OSA is crucial to ensure patients continue to use their equipment and become familiar with it. When compliance strategies are followed, CPAP compliance rates greater than 70% can be achieved.5
In one study, compliance monitoring including consistent follow-up, “troubleshooting,” and regular feedback to both patients and physicians achieved CPAP compliance rates greater than 85% over 6 months. There was a decrease in the Epworth Sleepiness Scale (ESS) score of 44% by 2 weeks of therapy, and the patients continued to improve over the follow-up period, with the lowest mean ESS score observed at 6 months.5
OSA is a common and under-diagnosed disease associated with significant morbidity and mortality. The cost implications of OSA when left untreated are potentially immense. These costs are associated with occupational injuries, motor vehicle crashes, reduced work productivity, and associated morbidity (including the development of cardiovascular and cerebrovascular disease). CPAP therapy would likely reduce these costs potentially making it an excellent use of healthcare resources.4
The Making Sleep Work for Yousm Compliance Approach
MSWFY uses a two-pronged approach to assess subjective and objective data while educating patients on their condition and helping them adjust into their routine with new PAP equipment. Employees are contacted via telephone within the first week of set up to go over any concerns they may be having in regards to air pressure, mask fitting, leaks, and other issues as they arise. They are also contacted at the end of months one, two, and three, and then quarterly thereafter to receive any updates in regards to pressure, leaks, and mask fittings and answer a list of questions to ensure they are properly using their equipment.
The second approach to tracking compliance is through automatic data download off of the PAP therapy machine. Each night it records the usage data, and MSWFY has the ability to download this information off of the machine. This can be done per week or per month to ensure the person is actually using their equipment. If a person stops using their machine altogether, MSWFY will contact them to ask what problems they are having and why it is they ended their therapy. Issues are addressed and we work with them to ensure they are on the right track to a good night’s sleep.
1 Pruitt, Bill. “Top 10 Practices to Increase CPAP Compliance.” Sleep Review. October 2008.
2 Weaver, Terri E. “Predicting Adherence to Continuous Positive Airway Pressure – The Role of Patient Perception.” Journal of Clinical Sleep Medicine, Vol. 1, No. 4, 2005.
3 Basner, Robert C. “Continuous Positive Airway Pressure for Obstructive Sleep Apnea.” The New England Journal of Medicine. Vol. 356: 1751-1758, No. 17, April 26, 2007.
4 Ayas, Najib T, et. al. “Continuous Positive Airway Pressure Therapy for Obstructive Sleep Apnea Syndrome: Do the Dollars Make Sense?” SLEEP, Vol. 28, No. 10, 2005.
5 Sin, Don, et. al. “Long-term Compliance Rates to Continuous Positive Airway Pressure in Obstructive Sleep Apnea.” Chest 2002; 121; 430-435.
