CPAP and mask comfort is important to patient satisfaction and compliance. Yet the choice of the first mask varies across Sleep Centers and labs, DMEs, providers, patients, and coverage. We evaluated whether requesting masks changes after the initial CPAP fitting was associated with compliance or the type of medical insurance. We hypothesized that CPAP adherence would be higher in patients who changed their mask. Penn CPAP Program patients are all fitted by a lab technician, provider, or DME. We examined data on requests for replacement of the first mask among new CPAP prescriptions over a 6-month period (January - June 2017). We compared the rates of compliance in the first 90 days between those with and without mask replacements using chi-squared tests and whether these differences were dependent on specific insurers. Of 1065 new CPAP patients, 302 (28.4%) requested replacement of the first mask within the first 90 days. Rates of treatment compliance did not differ between those with (67.9%) or without (68.8%) CPAP mask replacements (p=0.7691). Patients with Medicaid and Medicare had a higher rate of mask replacements (31.1% and 32.3%, respectively) than patients with Commercial (25.9%) or other insurance (22.9%) on average, although the difference did not reach statistical significance (p=0.133). In this study of our patients with personal mask fittings, 28.4% requested a replacement of the first mask during the initial compliance period. At 90 days, their compliance was similar to those who did not change first masks. While changing a mask may take days/weeks out of the 90 day compliance window, compliance did not appear decreased by time taken to change to a second preferred mask. There was some evidence of increased mask replacement in Medicare or Medicaid patients. none.

We previously analyzed CPAP use times in our urban sleep clinic before and after the 2009 CMS compliance rules for ongoing PAP coverage >90 days. We found no difference in use times despite changes in insurance rules, workflow and adherence interventions or ongoing mask, unit, tracking technology changes (2011 APSS abstract: CPAP Treatment Adherence in CPAP Clinics: Schutte-Rodin et al). Here, we examine whether type of insurance is associated with CPAP adherence rates. CPAP compliance rates were evaluated over a 30-month period (January 2015 to June 2017) among patients with Commercial insurance, Medicaid, Medicare or other insurance. Compliance was defined using the standard CMS rule PAP use times. We compared compliance rates among and between insurance carriers using chi-squared tests. De-identified data were analyzed for 4,285 patients with new PAPs set-up by a DME between January 1, 2015 and June 30, 2017. A total of 1776 (41.4%) of patients had Commercial insurance, 641 (15.0%) Medicaid, 1251 (29.2%) Medicare, and 617 (14.4%) had another or no insurance. The average PAP compliance among all patients was 68.6%. There were significant differences in compliance rates among insurance carriers (p<0.0001), with compliance rates among Commercial (73.9%) and Medicare (73.7%) patients significantly higher than compliance rates among patients with Medicaid (55.1%) or other or no insurance (57.4%). The identification of groups at increased risk of non-adherence to PAP is important in improving overall treatment adherence and efficacy, and, relatedly, in identifying risk-specific interventions to improve patient outcomes. Our data indicate that insurance type is an important predictor of CPAP adherence. Further studies are needed to understand the related factors mediating these associations. Additionally, given the increased focus on quality measures and provider pay for performance, and the expected negative effect of lower adherence, these factors should also be taken into account when evaluating performance metrics of individual providers, hospitals and DMEs. none.