0537 Enhancing PAP Adherence in Black and Hispanic Patients Utilizing an Automated Telemonitoring Intervention

• Published in: Sleep (New York, N.Y.) Vol. 47; no. Supplement_1; p. A230
• Main Authors: Hwang, Dennis, Yan, Rui, Arguelles, Jessica, Jemmott, John, Klimper, Matthew, Rosen, Ilene, Keenan, Brendan, Kuna, Samuel T, Maislin, Greg, Mazzotti, Diego, Pack, Allan, Saconi, Bruno, Watach, Alexa, Shi, jiaxiao, Becker, Kendra, Kim, Joseph, Sawyer, Amy
• Format: Journal Article
• Language: English
• Published: 20.04.2024
• ISSN: 0161-8105; 1550-9109
• DOI: 10.1093/sleep/zsae067.0537

Abstract Introduction The Tele-OSA randomized trial demonstrated improved PAP adherence in obstructive sleep apnea (OSA) patients receiving a telemonitoring intervention (automated messages triggered by low usage [U-Sleep, ResMed]). We conducted a sub-group analysis to explore the effect of the intervention in Black and Hispanic adults (B/H) compared to adults of all other races/ethnicities. Methods Tele-OSA (Kaiser Permanente; Fontana, CA) enrolled 556 patients with OSA [AHI≥5] newly initiated on PAP (AirSense 10, AutoCPAP) and randomized to Telemonitoring (TM) or Usual Care (UC). TM showed improved adherence compared to UC at 3 months (primary endpoint). TM was further split into two groups: those in which the intervention was discontinued per-protocol at 3 months (TM3) and those inadvertently continued indefinitely (TMC). Post-hoc analysis revealed that the TMC group maintained higher PAP adherence than the UC group over two years, while the TM3 group showed no difference from UC. In the current study, we conducted a sub-group analysis comparing adherence (mean “minutes/night” and “% days used”) between B/H and all other races/ethnicities in the TMC and UC groups across four time intervals: 3-6; 6-12; 12-18; 18-24 months. Kruskal-Wallis tests were used to compare the groups at each time interval. Results Of the 556 trial participants (50.5±12.1 years; 58.6% male, AHI 31.9±25.8), 269 were B/H (221 Hispanic; 48 Black) and 287 were non-B/H (233 White; 39 Asian). At baseline (i.e., Usual Care) B/H adults consistently showed lower adherence compared to non-B/H over two years (min/night for each time interval: 170.9±164.7 vs 195.5±172.5; 144.2±168.4 vs 167.1±172.7; 128.0±169.3 vs 158.9±181.2; 119.5±170.2 vs 148.1±184.3). B/H TMC participants had equivalent or higher PAP use compared to non-B/H TMC participants at each interval (251.8±142.1 vs 235.2±175.77; 211.2±152.1 vs 204.9±175.3; 190.4±168.3 vs 180.3±182.5; 163.3±180.2 vs 158.9±184.9). Similar findings were seen when analyzing “% nights used”. Conclusion Our study findings show that B/H adults had lower PAP adherence compared to non-B/H adults over a two-year period. Notably, a TM intervention effectively closed the disparity gap, resulting in similar PAP adherence levels for B/H and non-B/H adults. These findings underscore the importance of rigorously testing distance-accessible strategies to enhance PAP adherence and promote health equity. Support (if any) AASM Foundation104-SR-13