How Do Education, Social Support Affect PAP Adherence in Patients With OSA?

The group-based Sleep Apnea Management clinic at Cleveland Clinic's Sleep Disorders Center increased criteria-met adherence to positive airway pressure (PAP) therapy by 20% in patients with obstructive sleep apnea (OSA).

A group-based clinic providing mutual support and education on sleep apnea may significantly improve adherence to positive airway pressure (PAP) therapy in patients with obstructive sleep apnea (OSA), according to study findings published Sleep and Breathing.

As the gold standard treatment of OSA, PAP therapy has been found to significantly lower hospitalization risks and all-cause health care costs in patients with the condition. However, adherence to PAP has been indicated as a common barrier in treatment of OSA and other conditions.

Researchers note that established clinics that provide patients with support, education, and motivation have been found to be effective in improving adherence to therapies for conditions such as obesity, diabetes, and heart failure.

With effectiveness of group clinics on PAP adherence in those with OSA remaining unknown, the study authors examined the association in patients of the Sleep Apnea Management (SAM) clinic at Cleveland Clinic's Sleep Disorders Center.

“The multidisciplinary visit team focuses on the direct troubleshooting of technical issues and addresses any additional barriers that may be limiting treatment adherence,” said the researchers.

Utilizing Cleveland Clinic electronic medical record data to identify and select the patient population from January 2017 to June 2018, they derived adherence data of 110 SAM clinic attendees (average [SD] age, 60.9 [12.7] years; 53% men; 46% Caucasian) at their baseline visit and after 1 to 3 months of follow-up.

Participants were assessed for average PAP usage from all-days and days used, demographics, comorbidities, and Epworth Sleepiness Scale. Adherence was defined as 4 hours or greater for 70% or more of nights over a 30-day period.

“Key structural elements of the SAM group clinic model were copresence of the OSA care team members and peer group support,” explained the study authors. “Key efficiency elements were group education and the prompt-to-patient multidisciplinary troubleshooting adherence barriers.”

In examining patients at baseline, the mean for average-all-days usage was 4.2 hours, the mean average-days-used usage was 5.2 hours, and the mean percentage-of-days with usage meeting adherence criteria was 56.7%.

After follow-up, each reported rate was significantly improved:

  • Mean average-all-days usage was 5.41 hours, an increase of 1.18 hours (P < .001)
  • Mean average-days-used usage was 6.04 hours, an increase of 0.83 hours (P < .001)
  • Mean percentage-of-days with usage meeting adherence criteria (≥ 4 hours) was 73.04%, an increase of 16.34 percentage points (P < .001)

Moreover, patients meeting the criteria of PAP adherence were found to improve from 46% at baseline to 66% at follow-up.

Noting that the study was conducted prior to the COVID-19 pandemic, the researchers say that their model for the SAM clinic has since changed to virtual group visits with smaller group numbers overall.

“However, the principle practice remains the same and we suspect continued success in improving patients’ overall adherence,” they said.


Tran K, Wang L, Mehra R, et al. Impact of the sleep apnea management group clinic on positive airway pressure adherence. Sleep Breath. Published online April 29, 2021. doi:10.1007/s11325-021-02352-w

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