Adherence To Home Mechanical Ventilation Over 10-Years:A Retrospective, Single-Centre Cohort Study

Sleep-Disordered Breathing (SBD) can be associated with hypercapnic respiratory failure (HRF). Home Mechanical Ventilation (HMV) is the preferred treatment for those with HRF. We reviewed the database of a large tertiary referral centre for HMV to understand the adherence to HMV of patients with HRF over the last decade. Data on adherence and characteristics of patients who received HMV for the treatment of SDB over a decade were collected retrospectively using electronic patient records. The primary outcome parameter in this study was non-adherence rate (discharged divided by all new patients of the same year; usage 0-4 hours/night), secondary outcomes were patients’ characteristics and reasons for low adherence. During this period HMV adherence clinics were established to improve uptake. 2,228 were established on HMV at the end of the decade, while 1,900 patients had their HMV contracts terminated due to non-adherence, transfer to other services and death. 222 patients (62(52-72)years, BMI 40(35-43)kg/m2, 58.1%male, ESS 9(4-15)points, 4%ODI 32(20-71)/hour, tCO2 6.6(6.0-7.2)kPa) met the non-adherence criteria, with rates declining from 25.5% of new setups in 2010 to 3.4% in 2019 (relative reduction of 86%, p<0.001). Patients with OSA (58.2%), neuromuscular disease (26.8%) and COPD (13.6%) accounted for this non-adherent cohort. Most patients (96.1%) were established on full-face masks. Weight loss (23.4%), general displeasure (21.3%), uncontrolled symptoms (12.8%), claustrophobia (6.7%), mood (4.8%) and mask intolerance (4.3%) were the most common reasons for low adherence. Non-adherence rates to HMV in patients with chronic HRF decreased from about 1/4 to 1/30 new patient setups over the last decade.