Implementing a sleep technician supervised and personalized APAP interface fitting session prior to initiation of home APAP therapy improves adherence in patients with obstructive sleep apnea

Home Automatic Positive Airway Pressure (APAP) therapy is becoming a mainstay treatment of obstructive sleep apnea (OSA). It is typically prescribed without any prior supervised titration. Initial experience of APAP treatment dictates subsequent use. Discomfort related to the APAP interface contributes to poor APAP adherence. After obtaining IRB approval, 156 adult patients newly diagnosed with OSA were prospectively randomized into two groups (groups A and B). Group A received a 30-minute personalized interface/mask fitting session supervised by a certified sleep technician during which APAP therapy was simulated and patients were educated on proper use. Patients sampled different interfaces to address any issues with comfort. Group B received usual care where patients obtained an interface through Durable Medical Equipment suppliers. Primary endpoints included percent APAP usage (number of days APAP was used for ≥4 hours divided by 30 days) and APAP usage (number of days APAP was used for any duration) during the initial 30 days of home APAP therapy. Interface associated air leak served as the secondary endpoint. Mean percent APAP usage was higher in group A compared to group B (78.4% vs 67.8%; p=0.04). On average, group A utilized the APAP machine on more days compared to group B (27 vs 24 days; p=0.01). APAP interface associated air leak was lower in group A compared to group B (14.9 vs 21.1 l/min; p=0.03). Our findings demonstrate that implementing a personalized interface fitting session supervised by a sleep technician improves APAP adherence.