PAP compliance comes into sharper focus

The sleep therapy market continues to evolve with enhanced clinical awareness, better CPAP system technology and deeper understanding of obstructive sleep apnea and related disorders. The key to progress in efficacy and positive outcomes, sleep specialists say, remains patient compliance. The more patients who commit to using CPAP, the more benefits the industry generates.

CPAP compliance has been the focus of various studies over the years and sleep clinicians like Angela Giudice review the data methodically to get a clearer understanding of patient adherence factors. For instance, the American Academy of Sleep Medicine conducted a study that demonstrated if a CPAP patient misses two consecutive nights of therapy, there is a much greater risk of discontinuing use of the device.

Giudice, director of clinical education for Winter Haven, Fla.-based 3B Medical, adds that, “there are studies that show that catching a patient early enough can salvage compliance. For example, bedtime variability is a significant predictor of CPAP adherence, and compliance data easily shows if a patient is at risk.”

By analyzing compliance data, Giudice says clinicians can identify risk factors, “which provides ways to work smarter, not harder, so they can spend more time with patients that need an early
intervention.”

Advanced CPAP technology enables the devices to collect outcomes data for determining optimal critical care pathways for each apnea patient. The capability of linking real-time data from the patient to clinician, while sound, has been woefully underutilized to date, Giudice said.

“CPAP machines are cellular connected devices—there are multiple data points that conceivably could piggyback data on the CPAP device,” she said. “In that sense, the CPAP could be viewed as the gateway to a patient management system.”

Moreover, other data-generating health care products, such as blood pressure, pulse oximetry and glucose monitors, could transfer via Bluetooth to the CPAP and then be relayed during the data uploading to the cloud, Giudice said.

“In the future, viewing the CPAP as the central hub for personal patient medical data would help determine optimal critical care pathways for apnea patients with overlapping medical conditions and comorbidities,” she said.

Improving comfort

Camas, Wash.-based CPAP Comfort Cover is dedicated to offering a product line designed for enhanced CPAP compliance, specifically addressing the issue of mask discomfort. General Manager Norman Paulk is a CPAP user himself and found the inspiration for his company after developing severe red facial pressure marks and sores from his mask.

“I tried a commercial cotton cloth product to place over my mask before placing it on my face, but it was not as effective as I would have liked,” he said. “So my wife Vicki and I went to work on developing a solution that would work for me and other CPAP users.”

Because he's not a physician or licensed sleep technician, Paulk consulted sleep specialist Steve Scheer, M.D., about the potential effectiveness of the CPAP Comfort Cover. Scheer acknowledges that mask fitting and comfort has long been “a troublesome issue.”

There are various conditions that cause CPAP mask discomfort, Scheer said, such as the sense of being tethered, awkward feel and the sound of air leaks.

“Sadly, this often causes a downward spiral that can lead to patient mortality,” he said. “Accordingly, any innovation that leads to improved patient compliance will save lives.”

Contact dermatitis—the persistent pressure contact between mask material and a patient's face—presents another burdensome problem for mask wearers, Scheer said. While the introduction of mask liners helped with mask fit and comfort, he said the CPAP Comfort Cover addresses more specific issues.

“Previous mask liners failed to fully address the long-felt need in the industry for a product that would increase patient compliance by staying in position through the sleep period, preventing air leaks, preventing contact dermatitis and enhancing wearer comfort, while having consistently good ease-of-use across the full spectrum of patients,” he said. “CPAP Comfort Covers solve this long-felt need because they provide the above-listed benefits to the full spectrum of patients, by requiring virtually no manual dexterity or attentiveness to attach to a CPAP mask, due to their elastic retention. They can also be removed, laundered and replaced with little effort and little apparent diminution of
effectiveness.”