Impact of a multidisciplinary sleep apnea management group clinic on positive airway pressure adherence and patient-reported outcomes: a randomized controlled trial.

Abstract

Introduction: Positive airway pressure (PAP) is the mainstay of treatment for obstructive sleep apnea (OSA). However, suboptimal adherence significantly limits its effectiveness. This study examined the impact of a Sleep Apnea Management (SAM) clinic-an innovative, interactive group intervention providing interpersonal support, education, and resources-on PAP adherence and patient-reported outcomes (PROs) compared to usual care.

Methods: Participants with OSA who were newly prescribed PAP therapy and demonstrated suboptimal adherence (defined using CMS criteria during the first two weeks) were randomized to the SAM clinic (n = 26) or usual care (n = 30) from April 2019 to November 2022 (NCT-03835702). The primary outcome was the change in average daily PAP usage. Secondary outcomes included changes in the Epworth Sleepiness Scale (ESS), Patient Health Questionnaire-9 (PHQ-9), and PROMIS scales from baseline to 1 and 3 months. Baseline-adjusted mixed-effects linear and logistic models estimated differences between and within groups.

Results: Fifty-six participants were enrolled with a mean age of 55 years, 57% female, 63% Caucasian, median AHI of 22.8 (IQR: 9.3,39.6), and median baseline PAP usage of 172 min. After 3 months, the mean (95% CI) SAM clinic daily PAP use was 193 (139, 247) minutes vs usual care at 148 (110, 185) minutes with a mean difference of 46(-8, 99) minutes per day (p = 0.093). Within each group, a mean daily difference of 11(-36,57) minutes (p = 0.65) in SAM clinic and -32(-75,12) (p = 0.15) in the usual care was observed. No significant differences were observed in PROs between SAM and usual care. Within each group, ESS change was -0.7(-2.5,1.2) (p = 0.48) in SAM clinic and -2.5(-4.2, -0.83) (p = .004) in usual care. Significant decrease was noted in PHQ-9 within both SAM clinic at-2.2(-3.9, -0.4) (p = 0.019) and in usual care at -2.3(-4.0, -0.7) (p = 0.006). Improvement in PROMIS sleep-related impairment was noted within both groups: SAM clinic at -3.0(-6.2,0.1) (p = 0.059) and usual care group at -3.5(-6.4, -0.60) (p = 0.019). Similar changes in PAP adherence and PROS were seen at the 1-month follow-up.

Conclusion: The SAM clinic demonstrated trends toward improved PAP adherence and PROs compared to usual care, though differences were not statistically significant, likely reflecting the study's small sample size and other methodological constraints, larger, adequately powered studies are needed to confirm these findings and further explore the impact of SAM clinics on PAP adherence and patient outcomes.