Effectiveness of mailed versus in-person PAP initiation in the Veterans Affairs' TeleSleep program.

Abstract

Study objectives: This study sought to evaluate whether telehealth setup was noninferior to in-person setup for veterans initiating positive airway pressure (PAP) therapy.

Methods: PAP setups before and after the COVID-19 pandemic were identified at 2 Veterans Affairs health systems. Telehealth PAP setups occurred between March 2020 and December 2021. The in-person PAP setups occurred between January and December 2019. PAP data were extracted for days 1-30 (month 1) and 60-90 (month 3). PAP use was compared between in-person and telemedicine using hours used per night, days used (out of 30 days), and residual apnea-hypopnea index (among adherent users). Noninferiority analyses were performed, using the following noninferiority margins: 45 minutes for hours used, 4 days for days of usage, and 5 events/h for residual apnea-hypopnea index.

Results: A total of 432 Veterans Affairs patients (93.5% male) who underwent PAP setup were included (224 in-person; 208 telehealth). Noninferiority was established for PAP usage at month 1 (90% confidence interval [CI] = -0.31, 0.53) and month 3 (90% CI = -0.18, 0.71), days used at month 1 (90% CI = -2.28, 1.33) and month 3 (90% CI = -1.75, 2.20), and residual apnea-hypopnea index at month 1 (90% CI = -0.40, 1.62) and month 3 (90% CI = -0.69, 2.30).

Conclusions: Initiation of PAP therapy via telehealth was noninferior to in-person setup visits in terms of PAP adherence among veterans who use Veterans Affairs care.

Citation: Gomez A, Sarmiento KF, Smith C, et al. Effectiveness of mailed versus in-person PAP initiation in the Veterans Affairs' TeleSleep program. J Clin Sleep Med. 2025;21(8):1379-1387.