Improving Standards of Sleep Apnea Care


William Noah, MD, director and founder of the Sleep Centers of Middle Tennessee, discussed findings from his study on PAP adherence.

William Noah, MD, director and founder of the Sleep Centers of Middle Tennesse

William Noah, MD

Better long-term adherence to positive airway pressure (PAP) therapy is seen in patients with obstructive sleep apnea (OSA) who receive PAP machines from an integrated sleep practice (ISP) than those who obtain the device from traditional durable medical equipment suppliers (DMEs), data from a recent study suggest.

Researchers observed that the ISP group had a 71% (n = 1296) rate of PAP adherence at 30 days, a 66% (n = 1212) rate at 90 days, and a 52% (n = 961) rate at 1 year. These rates were significantly higher than those in the DME group, which had a 66% (n = 1327) rate of adherence at 30 days (P = .004), a 56% (n = 1116) rate at 90 days (P <.00001), and a 33% (n = 665) rate at 1 year (P <.00001). The ISP group also had a significantly greater duration of PAP use, with 357 minutes compared with 345 in the DME group at 30 days (P = .002), 348 versus 319 at 90 days (P <.00001) and 312 versus 164 at 1 year (P <.00001).

NeurologyLive spoke with study co-author William Noah, MD, director and founder of the Sleep Centers of Middle Tennessee, to learn more about the differences in care provided by an ISP versus DME as it relates to OSA treatment. He also stressed the importance of raising awareness and understanding of OSA.

NeurologyLive: Looking at your findings, how do think OSA care should shift?

William Noah, MD: Whether you’re looking at ISPs or DMEs, what we need is remote monitoring,and this is what sleep physicians should be doing. Our 2 groups of patients, the ISP and DME-supplied groups, were age-, sex-, and race-matched. They're all our patients, so they got the same studies and office visits, but the difference was where they got the cPAP [continuous positive airway pressure]. Adherence was 66% in our group at 1 year and 44% in their group that were still using, so a 50% increase. So, with this study, we found that our group did so much better partly because of the integration that we had in the machine, but partly because we had staff that was monitoring them making sure they were adhering all the way through 3 months. Some DME patients need that as well. Going forward, the big thing is our monitoring.

What we're really excited about is doing remote monitoring for the Medicare patients so we no longer have to give 2 levels of care, instead of Medicare patients getting their PAP machines through DMEs without monitoring. You can’t have 2 standards of care in the same practice. I don’t think the remote monitoring will be as good as the monitoring we build into our machines, but it’ll be closer.

Were there any findings that surprised you?

The coolest thing I found was that it's almost linear adherence. In other words, if you graph age and adherence, it’s almost linear, starting with younger people having the lowest adherence. That’s important because we really need to spend more time and more effort with younger individuals.

African American patients also had slightly lower adherence and they also sleep less. Granted, our population was very skewed, around 85% Caucasian and about 10% African American, but we need to figure out if we are not communicating well to those patients. Could we be communicating better? Are there cultural differences we need to take into account so that everyone gets the same treatment? 

Transcript edited for clarity.

Andry JM, Tobin G, Shafin C, Noah W. Positive airway pressure therapy supplied by an integrated sleep practice associated with greater adherence among pre–Medicare-aged patients with sleep-disordered breathing. J Clin Sleep Med. 2021. 17(1):31-36. doi: 10.5664/jcsm.8786
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