Obstructive Sleep Apnea (OSA) describes a situation when there are frequent pauses in breathing during sleep due to an obstructed airway. Continuous Positive Airway Pressure (CPAP) is a preferred and effective treatment which is considered to be the gold standard of OSA therapy1.2 . At least 4 hours usage of CPAP is suggested to maintain an effective and long-term therapeutic improvement and reduce the risk of comorbidities associated with untreated OSA220.127.116.11. However, maintaining high compliance with CPAP device could be difficult for some patients. It may lead to the following issues:
|Daytime fatigue and vehicle accidents
OSA patients with poor CPAP adherence may have impaired sleep quality due to the constant interruption of breathing. Sleep fragmentation will cause excessive daytime sleepiness affecting daily life. For example, truck drivers suffering from OSA have higher risk of vehicle accidents by as much as 250% compared to well-rested drivers7 . Thus, the patients compliance of CPAP therapy can increase the effectiveness of the OSA treatment and decrease the incidence of vehicle accidents compared to untreated OSA patients8.9.
OSA related comorbidities and complications
There are several studies10 reported that OSA patients show a high prevalence of the following comorbidities, including cardiovascular diseases (systemic hypertension, coronary artery disease, arrhythmias, ischemic stroke), respiratory diseases (COPD, asthma), and metabolic disorders (diabetes mellitus, dyslipidemia, gout). Also, peptic ulcer disease, gastroesophageal reflux, chronic liver disease, anxiety, insomnia, depression and even higher chances of getting cancer are identified in OSA patient population10.
|Reimbursement regulations (Regional)
The Centers for Medicare and Medicaid Services (CMS) defines an adequate CPAP adherence as using the CPAP device for ≥ 4 h for ≥ 70% of nights (within a 30 consecutive day period)11 . This has become a standard definition and CMS reimburses the costs of long-term CPAP therapy only if the patient is adherent during a 90-day trial12 . Thus, the reimbursement plan would be affected if patients with poor CPAP adherence.
There are many factors that can affect the patients’ compliance of using CPAP8, such as dry nose, nasal congestion and daytime fatigue. In order to solve these problems, Apex can help!
There are several technical approaches for increasing patients comfort level while using Apex's CPAP series, such as applying a heated humidifier and turning PVA (Pressure Variation Algorithm) function on. Using a heated humidifier can prevent the nose and mouth dryness and PVA function allows users to breathe out more easily by reducing the air pressure during exhalation. In addition, the cloud-based patient management system of Apex CPAP device offers timely data transmission to connect with medical professionals and patients. Allows medical professionals to monitor patient's sleep data, provide prompt suggestions, improve the clinical process, and save the time of visits.
Furthermore, choosing a suitable mask is one of important considerations for CPAP users in terms of increasing the CPAP compliance13.14.15. In order to have a restful sleep, CPAP users keen to find a mask with its design providing the convenience of wearing a mask, the freedom to change body position during sleep and high comfort level without air leakage issue according to their sleep habit.
Apex provides a variety of CPAP mask options to our customers, including Nasal mask, Full-face mask and Nasal pillow mask. Our masks feature contour fitting cushion, pressure redistribution on cushions, convenient tubing system, quick-released swivel and 3D-shaped headgear. Those characteristics are designed in Apex CPAP masks to provide users a comfortable and enjoyable CPAP therapy experience and sustain high CPAP compliance!
Why CPAP Patients Should Comply with Therapy
We recently discussed a few tips and tricks CPAP patients can use to stay compliant. In that article we briefly touched upon one of the cornerstones of successful therapy: tracking compliance.
Many insurance companies want to make sure their clients are using the expensive equipment that was paid for. To ensure minimum CPAP usage, some of these insurance companies want a detailed report as often as every three months. For the most part, they want to know how many days a week patients are using their device and how many hours a night they are using it for. And if patients don't meet a minimum standard (usually four hours a night/four days a week) they may ask patients to reimburse the company for the equipment.
Aside from just the fear of having to pay for these expensive pieces of equipment out of pocket, patients should be concerned about the usage rates for their own health.
Sleep apnea is often overlooked as a mere annoyance because of the subsequent loud snoring that is often produced as a result of partial blockage. However, many people may not realize that a slew of medical complications can arise as a result of untreated sleep apnea including cardiovascular problems (ranging from irregular heart rhythms to heart disease, stroke, and heart failure), complications during surgery, mood disturbances, depression, and even driving and industrial accidents resulting from sleep deprivation.
Patients who are serious about their overall health and well-being should take CPAP therapy seriously, and the best way patients can do that is by keeping track of their own progress and having a good understanding of how their machine works, and what they can do to make it work better.
Here are a few ways patients can track their progress:
Remote Monitoring/ SD card monitoring
Many clinics that dispense CPAP equipment include follow up care as part of their treatment program. Most CPAP devices have a slot in the machine allowing for either an SD card to capture data or a remote wireless device that uploads data to a cloud-based system.
Patients issued a machine with an SD card will have to periodically bring their card into the clinic offering the follow-up care periodically. How often they bring it in is either up to the insurance company, the clinic, or the patients themselves. At the clinic, the data can be uploaded and viewed or printed out.
Patients with a wireless monitoring system on their device don't have to worry about bringing anything in to the clinic. Technicians charged with follow-up care can upload data from the device at any time to view how well patients are complying with therapy.
Typical information stored on the machine's SD card or uploaded to the cloud include:
Days above 4 hours of usage
The patient's apnea/hypopnea index (AHI)
Leak rate of masks
- Total blower hours
Total therapy hours
Machine Data Displays
For patients that don't want to leave their therapy completely in the hands of the technicians, nearly all CPAP machines can display the data on the device's screen. Not only do patients have access to track all of the data listed above, they have the option to fine-tune their machine for maximum comfort, which can lead to better compliance.
Nearly all devices have pressure settings that are locked in by the issuing clinic based on the sleep specialist's prescription. And while the pressure setting can't be adjusted by the patient, many comfort features can be. These features include:
Humidifier settings allow patients to select the desired amount of moisture and temperature of the air being delivered.
The ramp feature allows a patient to select a starting pressure for their machine. Patients with high-pressure settings often have trouble being hit with the full volume of their prescribed pressure as soon as the machine is turned on. The ramp allows patients to select a lower pressure to start with that gradually builds to the prescribed pressure.
Mask alert is a feature that can allow patients to be alerted with an audible and/or visual alarm when there is a significant mask leak. This can alert the patient to wake up and adjust the mask for adequate therapy.
Some machines have a pressure relief option, which allows patients to soften the force of the incoming air upon exhalation. When patients exhale, the pressure lowers making breathing feel more natural and comfortable.
Some machines have features that only allow air to flow if the patient is wearing the mask. If a patient removes the mask, the machine will turn off. When the patient applies the mask, the air will begin flowing again.
Web based platforms/Mobile Apps
For technologically savvy patients or those that are constantly on-the-go, many CPAP device manufacturers now offer the ability to check compliance online or through mobile apps.
Availability of checking data from a computer or mobile device may depend on the machine. Many older devices may not have this capability.
Some of these features/apps may cost a small fee, while others may be free. Check with your provider to see if your device has a free feature for tracking compliance.
For more information on web-based and mobile app tracking software check out the following links based on the manufacturer of your machine.
Respironics System One devices offer SleepMapper for free
ResMed MyAir is available for AirSense 10 and AirCurve 10 patients free of charge
DeVilbiss IntelliPAP can generate compliance reports for a small fee
Regardless of how patients take action to monitor their compliance, the important thing is to make sure they are aware of the options available. For many patients, having a little control over their therapy goes a long way in engaging them with getting the best treatment possible. Patients who can see their mask leakage rates may be encouraged to try a new mask that works better. Knowing they can adjust their device's comfort features can make treatment more tolerable and likely to occur on a regular basis. And being able to see their cpap compliance numbers can influence them to make changes for the better.
And while they can't be forced to drink the water, we can at least hand them a refreshing glass.
APEX Sleep Therapy https://www.apexmedicalcorp.com/exec/product.php?cid=26&lg=E
- Becker HF, Jerrentrup A, Ploch T. Effect of nasal continuous positive airway pressure treatment on blood pressure in patients with obstructive sleep apnea. Circulation 2003;107:68–73.
- Rotenberg, B.W., Murariu, D. & Pang, K.P. Trends in CPAP adherence over twenty years of data collection: a flattened curve. J of Otolaryngol - Head & Neck Surg 45, 43 (2016).
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- Pavwoski P, Shelgikar AV. Treatment options for obstructive sleep apnea. Neurol Clin Pract. 2017;7(1):77-85. doi:10.1212/CPJ.0000000000000320
- Bradley TD, Floras JS. Obstructive sleep apnoea and its cardiovascular consequences. Lancet 2009;373:82–93.
- Kasai, T. and Bradley, T., 2011. Obstructive Sleep Apnea and Heart Failure. Journal of the American College of Cardiology, 57(2), pp.119-127.
- Croke, D. (2021). How sleep apnea causes trucking accidents? - FreightWaves. Retrieved 3 February 2021, from https://www.freightwaves.com/news/how-sleep-apnea-causes-trucking-accidents
- Tregear S, Reston J, Schoelles K, Phillips B. Obstructive sleep apnea and risk of motor vehicle crash: systematic review and meta-analysis. J Clin Sleep Med. 2009 Dec 15;5(6):573-81. PMID: 20465027; PMCID: PMC2792976.
- Filtness, A., Reyner, L., & Horne, J. (2011). One night’s CPAP withdrawal in otherwise compliant OSA patients: marked driving impairment but good awareness of increased sleepiness. Sleep And Breathing, 16(3), 865-871. doi: 10.1007/s11325-011-0588-8
- Bonsignore, M.R., Baiamonte, P., Mazzuca, E. et al. Obstructive sleep apnea and comorbidities: a dangerous liaison. Multidiscip Respir Med 14, 8 (2019).
- Mehrtash, M., Bakker, J., & Ayas, N. (2019). Predictors of Continuous Positive Airway Pressure Adherence in Patients with Obstructive Sleep Apnea. Lung, 197(2), 115-121. doi: 10.1007/s00408-018-00193-1
- Billings ME; Kapur VK. Medicare long-term CPAP coverage policy: a cost-utility analysis. J Clin Sleep Med 2013;9(10):1023-1029.
- Brill, A., 2014. How to avoid interface problems in acute noninvasive ventilation. Breathe, 10(3), pp.230-242.
- Bakker, J., Neill, A. and Campbell, A., 2011. Nasal versus oronasal continuous positive airway pressure masks for obstructive sleep apnea: a pilot investigation of pressure requirement, residual disease, and leak. Sleep and Breathing, 16(3), pp.709-716.
- Rowland, S., Aiyappan, V., Hennessy, C., Catcheside, P., Chai-Coezter, C., McEvoy, R. and Antic, N., 2018. Comparing the Efficacy, Mask Leak, Patient Adherence, and Patient Preference of Three Different CPAP Interfaces to Treat Moderate-Severe Obstructive Sleep Apnea. Journal of Clinical Sleep Medicine, 14(01), pp.101-108.