Confidence and belief in positive airway pressure (pap) importance and effectiveness are key pretreatment predictors of 90-day adherence

SESSION TITLE: OSA: New Therapeutic Targets SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/09/2023 12:00 pm - 12:45 pm PURPOSE: Psychological measures such as self-efficacy and outcome expectancy after starting PAP are associated with PAP adherence. We sought to understand whether beliefs and attitudes about OSA and PAP therapy and having identified support, before PAP therapy start, were associated with 90-day PAP adherence. METHODS: This is an analysis of data from a prior prospective, single-arm, multi-state feasibility pilot study of a remote OSA screening, diagnostic, and treatment pathway. Before PAP initiation, a secure web survey was delivered to participants with OSA for whom PAP therapy was recommended by a board-certified sleep physician. Likert scale responses were collected to the following: "I'm confident that I will be able to use PAP therapy”; “PAP therapy is effective for treating Sleep Apnea”; “Treating my Sleep Apnea is important to me”; and “I have someone who can support me in using PAP therapy" (responses: 1-5, strong disagreement to strong agreement). Follow-up lasted 90-days after device delivery, with PAP usage data collected remotely. We cross-tabulated survey responses and 90-day CMS adherence with Fisher exact tests for significance and trained regression trees with adherence as binary outcome of interest and first week usage data as feature. RESULTS: Of 105 participants (59% women), 99 (94%) completed the survey. Participants who responded 5/5 on confidence were significantly more adherent versus the rest (46/59, 78% vs. 19/40, 48%), (p = 0.0025). Those scoring 5/5 on both the Confidence and the Effectiveness questions were more likely to be adherent (41/50, 82%), than those scoring <5 on both questions (3/11, 27%) (p < 0.001). Using first week PAP data, >5.2 hrs use on at least one of the days was the single most important adherence predictor. In a regression tree model, strong agreement with both importance of treating OSA and with PAP effectiveness together were more predictive than confidence alone. CONCLUSIONS: Before therapy, high confidence in being able to use PAP was the single best predictor of 90-day adherence, as in prior research. Additional belief in PAP therapy effectiveness further improved predicted 90-day adherence. When incorporating first-week PAP data, belief in PAP’s effectiveness and the importance of OSA treatment persisted as better predictors of 90-day adherence than confidence alone. CLINICAL IMPLICATIONS: Approaches that combine early education regarding OSA and the importance of treatment, PAP therapy and effectiveness, and development of confidence and support for PAP may yield higher PAP 90-day adherence rates. First week PAP data may guide stepped-up support to benefit adherence. These are novel insights for best practice in OSA therapy and PAP onboarding, suggesting that simple, remote, targeted, educational and coaching approaches may improve 90-day treatment outcomes. DISCLOSURES: No relevant relationships by Cynthia Dorsey Employee relationship with Verily Life Sciences Please note: Feb 2019 to present Added 04/10/2023 by Emma Rudie, source=Web Response, value=Salary Consultant relationship with Verily Life Sciences Please note: 2019-2021 Added 03/14/2023 by Shannon Sullivan, source=Web Response, value=Consulting fee