P033 Randomised controlled trial on the efficacy of Audio-visual Health Educational materials on CPAP ADherence: The AHEAD trial

OSA is a prevalent chronic disease with significant health implications, for which achieving >4 hours/night on continuous positive airway pressure (CPAP) is essential for effective treatment. Educational videos to improve CPAP adherence are of interest as a low-cost intervention, however trials have shown mixed results. This study aimed to compare CPAP usage following standard of care education (SOCE), with the usage following the addition of educational videos, customised to incorporate low health literacy communication, motivational and self-efficacy techniques. Methods Adults with OSA recommended treatment with CPAP, were recruited and randomised in a single blinded method, to watch short educational videos following their in laboratory CPAP study or SOCE. The primary outcome was CPAP usage at 2mths and secondary outcomes were usage at 12mth and proportion of patients with adequate usage >4hrs/night. Results 195 patients met the eligibility criteria and were randomised to video education (n = 96) or to SOCE (n = 99). There was no significant difference in compliance at 2mths (median usage 1.7hrs IQR 0–6.2 SOCE, 4.4hrs IQR 0–6.7 video education p = 0.1), however at 12mths there was increased usage in the video education arm (median 0hrs IQR 0–5.4 standard of care, 3.8hrs IQR 0–6.87 p = 0.05). The proportion with adequate CPAP usage >4hrs/night at 12mths was higher in the video education group (33, 33% versus 48, 50% p = 0.01). Conclusions Long-term adherence to CPAP is enhanced by the addition of educational videos that incorporate low health literacy communication and motivational techniques, compared to SOCE.

P139 Co-morbid insomnia and sleep apnoea (COMISA): Identifying patients that are responsive to continuous positive airway pressure therapy

Introduction Co-morbid insomnia and sleep apnoea (COMISA) is a prevalent and debilitating condition that is difficult to treat. COMISA patients have lower average adherence to continuous positive airway pressure (CPAP) therapy compared to patients with sleep apnoea alone. However, a sub-sample of COMISA patients may show adequate CPAP use that improves both the insomnia and sleep apnoea. It is important to identify this group of CPAP-responsive COMISA patients to guide personalised-medicine approaches. Methods Seventy-three COMISA patients (AHI≥15; ICSD-3 insomnia; 55% male, Age M=57y) completed questionnaires, home-based polysomnography, and one-week sleep diaries before and 6-months after commencing CPAP therapy. No patients accessed CBTi. We investigated baseline predictors of CPAP adherence (min/night) and overall change in Insomnia Severity Index (ISI) scores during treatment. Results Average CPAP adherence was 205 minutes/night (SD=153). 56% of patients used CPAP at least 4h/night. Average CPAP adherence was predicted by higher baseline AHI (r=0.39), arousal index (r=0.28), N1 sleep (r=0.32) and age (r=0.26), and lower N3 sleep (r=-0.28). The ISI decreased from baseline (17.9, CI=1.2) to 6-month follow-up (11.6, CI=1.3; p<0.001). There was a significant positive association between ISI reduction and CPAP use (r=0.31). 26% of patients reported an ISI<8 at 6-month follow-up. Conclusion Approximately half of COMISA patients show CPAP adherence of ≥4h/night and one quarter experience insomnia remission with CPAP. CPAP use is positively associated with AHI, light sleep, and age at baseline, and reduction of insomnia severity during treatment. Future randomized controlled trials are required to confirm the results of this small un-controlled study.

Long-term effect of continuous positive airway pressure therapy on blood pressure in patients with obstructive sleep apnea

Obstructive sleep apnea (OSA) is a common cause of hypertension. Previous studies have demonstrated beneficial short-term effects of continuous positive airway pressure (CPAP) therapy on blood pressure. However, long-term antihypertensive effects of CPAP have not been properly verified. This study examined the longitudinal effect of CPAP therapy adherence on blood pressure among OSA patients. All patients diagnosed with OSA and undergoing subsequent CPAP therapy at a Kanagawa-area sleep clinic were clinically followed for 24 months to examine CPAP adherence, as well as longitudinal changes in blood pressure and body weight because it may become a confound factor for changes in blood pressure. The hours of CPAP usage were collected over the course of 30 nights prior to each follow-up visit (1st, 3rd, 6th, 12th, and 24th month). The relationship between CPAP adherence and blood pressure was analyzed using mixed-effect logistic regression models. A total of 918 OSA patients were enrolled in the study. We found a significant reduction in diastolic blood pressure among patients with good CPAP adherence during the 24-month follow-up period (β = − 0.13, p = 0.03), when compared to the group with poor CPAP adherence. No significant association was found between CPAP adherence and weight loss (β = − 0.02, p = 0.59). Long-term, good CPAP therapy adherence was associated with lower diastolic blood pressure without significant weight loss.

Telemedicine Strategy to Rescue CPAP Therapy in Sleep Apnea Patients with Low Treatment Adherence: A Pilot Study

Patients with sleep apnea are usually treated with continuous positive airway pressure (CPAP). This therapy is very effective if the patient′s adherence is satisfactory. However, although CPAP adherence is usually acceptable during the first months of therapy, it progressively decreases, with a considerable number of patients accepting average treatment duration below the effectiveness threshold (4 h/night). Herein, our aim was to describe and evaluate a novel telemedicine strategy for rescuing CPAP treatment in patients with low adherence after several months/years of treatment. This two-week intervention includes (1) patient support using a smartphone application, phone and voice recorder messages to be answered by a nurse, and (2) daily transmission and analysis of signals from the CPAP device and potential variation of nasal pressure if required. On average, at the end of the intervention, median CPAP adherence considerably increased by 2.17 h/night (from 3.07 to 5.24 h/night). Interestingly, the procedure was able to markedly rescue CPAP adherence: the number of patients with poor adherence (<4 h/night) was considerably reduced from 38 to 7. After one month, adherence improvement was maintained (median 5.09 h/night), and only 13 patients had poor adherence (<4 h/night). This telemedicine intervention (103€ per included patient) is a cost-effective tool for substantially increasing the number of patients with CPAP adherence above the minimum threshold for achieving positive therapeutic effects.

Cancer risk in patients with sleep apnoea following adherent 5-year CPAP therapy

BackgroundIncreasing evidence suggests that obstructive sleep apnoea (OSA) contributes to cancer risk; however, limited data are available on the impact of continuous positive airway pressure (CPAP) therapy on cancer incidence. We aimed to determine whether adherence to CPAP therapy is associated with a reduction in all-cancer incidence compared to non-adherent patients with OSA.MethodsThe study relied on the data collected by the multicentre study Pays de la Loire Sleep Cohort, linked to health administrative data, such as to identify new-onset cancer. We included patients who were prescribed CPAP for OSA, with no history of cancer before the diagnostic sleep study or during the first year of CPAP. Patients with documented CPAP use for at least 4 h per night were defined as adherent. Those who discontinued or used CPAP less than 4 h at night constituted the non-adherent group. A propensity-score inverse probability of treatment weighting analysis was performed to assess the effect of CPAP adherence on cancer risk.ResultsAfter a median [inter-quartile range] follow-up of 5.4 [3.1–8.0] years, 437 (9.7%) of 4,499 patients developed cancer, 194 (10.7%) in the non-adherent group (n=1817) and 243 (9.1%) in adherent patients (n=2682). The final weighted model showed no significant impact of CPAP adherence on all-cause cancer risk (sub distribution hazard ratio [95% confidence interval]): 0.94 [0.78; 1.14]).ConclusionsAdherence to CPAP therapy in OSA patients was not associated with a reduction in all-cancer incidence. Whether adherent CPAP therapy of OSA might reduce the risk of specific cancer sites should be further evaluated.