Apnea burden: efficacy versus effectiveness in patients using positive airway pressure.

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.