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Apnea burden: efficacy versus effectiveness in patients using positive airway pressure
Matt T Bianchi1, Yvonne Alameddine2, James Mojica3
1Neurology Department, Massachusetts General Hospital, Boston, USA; Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA.
Background:
Modern continuous positive airway pressure (PAP) machines track hours of use and residual respiratory events while on treatment. A substantial portion of sleep apnea patients are partially compliant, emphasizing the need to distinguish between PAP efficacy and PAP effectiveness in chronic management of patients with sleep apnea.
Methods:
We used a combination of three data sources to estimate the sleep apnea burden in a convenience cohort of PAP users from our clinics that were compliant based on Medicare criteria: self-reported habitual total sleep time, and PAP usage times with residual apnea-hypopnea index (AHI) from compliance downloads.
Results:
Assuming that the off-PAP time consists of baseline AHI severity, an estimated apnea burden was calculated to estimate PAP effectiveness. Whereas 70% of patients in our cohort showed machine AHI values <5/h, the apnea burden calculations revealed that only one-third of patients are predicted to have an effective AHI <5.
Conclusion:
Estimating PAP effectiveness through the concept of apnea burden has implications for clinical care as well as research trials.
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