Did COVID-19 impact Positive Airway Pressure adherence in 2020? A cross-sectional study of 8477 patients with sleep apnea

Abstract

Background: Whether the COVID-19 pandemic impacts Positive Airway Pressure (PAP) adherence over the long-term is unknown and only preliminary short-term data have been reported.

Methods: With the aim of describing the impact of the first and second waves of COVID-19 on PAP adherence during 2020 in France, we designed a cross-sectional study of Sleep-Apnea (SA)-patients under PAP telemonitoring. To examine PAP adherence in adult SA patients, we assessed de-identified data from a non-profit healthcare provider database during the period January 1, 2019 to December 31, 2020. Included patients met the following criteria: (i) PAP-treated for at least 4 months before January 1, 2019 and with continuous PAP during both 2019 and 2020; (ii) ≥ 360 daily PAP telemonitored data per year. For PAP adherence, data were collected using the PAP-software.

Results: 8477/10482 patients were finally included in the analysis [72.4% male, median age 70 years (IQ25-75: 61-77], 25.6% < 62 years old, initial Apnea-Hypopnea Index (AHI) of 41 (31-59)/h. Median PAP adherence was 7.21 (6.12-8.10) h/day in 2020 versus 7.12 (6.05-8.02) h/day in 2019, p < 0.001. The median difference in PAP adherence between the first 2020 lockdown and the corresponding 2019 weeks was 9.75 (CI95% 8.75-10.75) min/day, p < 0.001. The median difference in PAP adherence between the second 2020 lockdown and the corresponding 2019 weeks was 5.00 (CI95% 4.00-6.00) min/day, p < 0.001. If we consider the minimal clinically important difference of 30 min for PAP adherence, 30.4% and 26% of the patients increased their PAP adherence by at least 30 min during the first and second lockdowns respectively; 17.6% and 19.3% of the patients lowered their PAP adherence by at least 30 min in the first and second lockdowns, respectively.

Conclusion: During the first and second lockdowns, the COVID-19 pandemic had a clinically irrelevant effect on PAP adherence for the study population. Future studies are needed to describe COVID-19 pandemic impact on PAP adherence not only for long-term PAP-treated SA patients but also for incident cases. Trial registration The COVADENE study was registered on March 1st, 2021 on ClinicalTrials.gov (Identifier: NCT04775966).

Keywords: And adherence; COVID 19; CPAP; Sleep Apnea.

Conflict of interest statement

Dr. Suehs reports grants and fees from AstraZeneca, a grant from GSK, outside the submitted work. Dr. Mallet reports personal fees from ADENE, outside the submitted work. Dr. Court-Fortune reports grants and personal fees from NOVARTIS, grants and personal fees from ASTRA ZENECA, grants and personal fees from SANOFI, grants and personal fees from GSK, grants and personal fees from BOEHRINGER INGELHEIM, outside the submitted work. Pr. Gagnadoux reports grants and personal fees from RESMED, personal fees and non-financial support from SEFAM, personal fees from CIDELEC, personal fees and non-financial support from NOVARTIS, personal fees from ACTELION, non-financial support from BOEHRINGER INGELHEIM, personal fees and non-financial support from NYXOAH, non-financial support from ASTEN, outside the submitted work. Dr. Jean Christian Borel reports grants and personal fees from Philips, salaries from AGIR à dom, personal fees and other from RESMED, other from NOMICS, outside the submitted work. Pr. Bourdin reports grants, personal fees, non-financial support and other from GSK, grants, personal fees and other from Astra Zeneca, grants, personal fees and other from Boehringher Ingelheim, grants, personal fees and other from Novartis, grants, personal fees and other from Chiesi Farma, grants, personal fees and other from Teva, other from PneumRx, personal fees and other from Actelion, grants from Merck, outside the submitted work. Dr. JAFFUEL reports personal fees from Philips Healthcare, personal fees from Resmed, personal fees and non-financial support from SEFAM, personal fees from Lowenstein, personal fees from GSK, personal fees from Boehringher Ingelheim, personal fees from Jazz, grants and personal fees from Novartis, personal fees from Astra Zeneca, personal fees from Chiesi Farma, personal fees from SANOFI, outside the submitted work. FB, OG, NM, report no conflicts of interest in relation to the present work.

© 2022. The Author(s).

Figures

Fig. 1

Median PAP adherence (h/day) per week and the proportion of adherent patients per week for the year 2019 (A) and 2020 (B)

Fig. 2

Sankey diagram for the minimal clinically important difference (MCID) of 30 min for PAP adherence in 2020 versus corresponding 2019 periods