By: Joseph W. Anderson, CCSH, RPSGT, RST, RPFT, CRT-NPS on March 29th, 2018
Digital Tech Takes on PAP Adherence
Despite all this talk of “adherence” or “compliance,” few PAP users or technologists know the precise definition. This can be problematic not only in analyzing the effectiveness of therapy, but also in getting insurance to resupply the patient. For the sake of this article, we will use the more accepted term “adherence” interchangeably with the term “compliance.”
What Is PAP Adherence?
Unfortunately, there is no single definition. However, most practices use the definition given by Medicare, which stipulates the following:
- Compliance (adherence) is measured over a 30-day consecutive period
- CPAP is being used 70 percent or more of the time
- CPAP is being used for four-plus hours everynight
So, for example, if you get an average of eight hours of sleep over 30 days (240 hours total), you would need to be using your PAP machine for an average of 5.6 hours each night.
There are problems qualifying what PAP adherence is, but there are still more problems quantifying how many patients are adherent. Estimates of patients’ adherence range from 29-83 percent, which is an extremely wide margin.
Patients generally “decide” to comply (adhere) within the first week (generally by the second to fourth night) of using their CPAP. The duration of these therapy sessions may meet the minimum requirements for adherence (i.e., four hours), but there is evidence that duration gradually increases from this point forward.
There are problems with defining and measuring compliance that are quite significant. Though many tests have drawn conclusions about the risks of noncompliance, these problems beg the question of how salient they truly are.
One study has found that at least six hours of sleep is needed to alleviate certain symptoms of sleep apnea, such as memory problems and daytime drowsiness. This is two hours greater than the unofficial benchmark that Medicare uses, and it’s also one hour greater than the average sleep time of those that do qualify as “compliant or adherent.”
So, is CPAP adherence truly that important? Despite all the problems with it, it nevertheless remains the best way to gauge how therapy is working for individual patients. But it is important to recognize the limitations of PAP adherence as a metric, given how it is currently quantified and qualified.
Some of the “how” related to patient data has changed over the last several years: This includes how we accumulate the adherence data, how we can see real-time patient data, how we store the data and how we “rely” on a digital world to monitor adherence.
What Do We as Technologists and Providers Want?
The Q1 2018 issue of A2Zzz answers this question. Joseph W. Anderson, CCSH, RPSGT, RST, RPFT, CRT-NPS, makes the critical link between the use of emerging technology and efforts associated with PAP adherence.
This article is one of four designated CEC articles in this issue of A2Zzz. AAST members who read A2Zzz and claim their credits online by the deadline can earn 2.00 AAST Continuing Education Credits (CECs) per issue – for up to 8.00 AAST CECs per year. AAST CECs are accepted by the Board of Registered Polysomnographic Technologists (BRPT) and the American Board of Sleep Medicine (ABSM).
To earn AAST CECs, carefully read the four designated CEC articles and claim your credits online. You must go online to claim your credits by the deadline of June 8, 2018.
After the successful completion of this educational activity, your certificates will be available in the My CEC Portal acknowledging the credits earned.