Effects of Mask Change/Renewal on Adherence to Positive Airway Pressure Therapy: Analysis of a Large Telemedicine Database

<b>Rationale:</b> Adherence to positive airway pressure (PAP) therapy is a common and challenging issue. Although some studies have looked at the impact of initial mask selection, there is a lack of data regarding the impact of a change in mask on adherence to PAP therapy. <b>Objectives:</b> This study investigated the impact of a mask change or renewal on midterm PAP adherence. <b>Methods:</b> German homecare provider data were retrospectively analyzed. Patients aged ≥18 years who started PAP therapy in 2014-2019, had data on the type of device and interface (mask) used, and had mask change/renewal within ≤1 year after starting PAP were eligible. Mask change was defined as switching to a different mask type, whereas mask renewal referred to supply of a replacement mask of the same type. The primary endpoint was change in PAP use after mask change/renewal, overall and in patient subgroups based on previous PAP use (<4 and ≥4 h/night). <b>Results:</b> A total of 12,551 patients were included (71% male; age, 62 ± 12 yr), and previous PAP use was <4 h/night (<i>n</i> = 3,510) or ≥4 h/night (<i>n</i> = 9,041). After mask change/renewal, there was no change in device use overall or in patients with previous use ≥4 h/night. However, in those with PAP use <4 h/night, mask change/renewal was associated with increased device use (+55 min [+57 min for change, +39 min for renewal), and it increased the proportion of days with PAP use ≥4 h/night by 19% (+20% for change, +12% for renewal). In this patient subgroup, early mask change/renewal (within 90 d), higher levels of previous device use, and older age were significant predictors of improving device usage to ≥4 h/night after mask change/renewal. <b>Conclusions:</b> For patients with low PAP adherence on their existing mask system, early intervention to change or renew the mask was associated with clinically relevant improvements in device use.