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 Jan 1;17(1):31-36. doi: 10.5664/jcsm.8786.


Study objectives: We investigated whether patient adherence to positive airway pressure (PAP) therapy was significantly different between groups whose PAP machines were dispensed by a traditional durable medical equipment (DME) supplier (DME group) versus those provided directly by an integrated sleep practice (ISP group).

Methods: This was a retrospective cohort study that analyzed 3884 patients (ages 18-64) who were set up with a new PAP machine for sleep-disordered breathing. The channel through which PAP therapy was dispensed (DME vs ISP) was chosen as part of the natural course of treatment, making patient choice and third-party payor likely important selection factors. We analyzed whether the groups had significant differences in adherence rates and nightly usage duration after 30 days, 90 days, and 1 year of therapy.

Results: The ISP group had a significantly higher rate of PAP adherence at 30 days (71% vs 66%; P = .004), 90 days (66% vs 56%; P < .00001), and 1 year (52% vs 33%; P < .00001) following initiation of PAP therapy, relative to the DME group. There was a significantly higher duration of PAP use among the ISP group at 30 days (357 vs 345 minutes; P = .002), 90 days (348 vs 319 minutes; P < .00001), and 1 year (312 vs 164 minutes; P < .00001).

Conclusions: This study suggests improved short- and long-term PAP adherence rates among patients who received PAP therapy through an ISP. As current health care trends drive sleep medicine practices to adopt chronic care management models, further studies are needed to better understand the tradeoffs of receiving PAP through traditional DME providers.

Keywords: CPAP; CPAP usage; adherence; obstructive sleep apnea; positive airway pressure; sleep apnea; sleep-disordered breathing.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Continuous Positive Airway Pressure
  • Humans
  • Medicare
  • Middle Aged
  • Patient Compliance
  • Retrospective Studies
  • Sleep
  • Sleep Apnea Syndromes* / complications
  • Sleep Apnea Syndromes* / therapy
  • Sleep Apnea, Obstructive* / therapy
  • United States
  • Young Adult