0609 Poor Long Term Positive Airway Pressure Use Is Common Among Veterans and Varies by Site of Care

Abstract Introduction Many Veterans who are diagnosed with OSA and prescribed positive airway pressure (PAP) therapy struggle to use it. Data on initial and longer term rates of Veteran adherence to PAP are not well described. We examined Veteran adherence to PAP in first and last 90 days of first year, and whether use varied by service location. Methods We examined PAP use in 502 patients who underwent diagnostic OSA testing at 7 geographically varied Veteran's Heath Administration (VHA) sites to which the Crescenz VAMC provides sleep services, were diagnosed with OSA and initiated treatment with continuous PAP therapy. T-tests were used to compare PAP use metrics between first 90 and last 90 days in the 365 days after PAP initiation. ANOVA was used to compare PAP use metrics among sites. Results Mean age was 57.8 (SD 14.2) yrs with 464 (92.4%) males. Patients were mostly White (64.1%) or Black (22.5%). Across all sites, in the first 90 days after devices were in service, mean daily PAP use was 164.0 (SD 163.2) minutes, with mean % days of any PAP use 49.4% (38.1), including 13.2% of patients with use on 0 days. In the last 90 days of the year, mean daily PAP use was 133.9 (118.3) minutes, with mean % days of any PAP use 35.8% (42.5), including 47.0% of Veterans with use on 0 days. Among patients with attempts to use PAP, mean daily use fell from 240.0 (154.7) minutes initially, to 175.5 (188.9) minutes in the last 90 days. Reductions in PAP use metrics were highly significant (all p< 0.0001). Highly significant differences in mean days of use and duration of daily use were observed among sites in both first 90 and last 90 days (all p< 0.0001). Conclusion Use of PAP therapy among Veterans across different VHA sites was limited in the first 90 days after PAP initiation, and declined further over the first year after PAP was dispensed. Differences in frequency and duration of PAP use were highly significant among sites, raising questions about how site-specific characteristics and patient characteristics influence PAP adherence. Support (if any) VA CHERP Eugene Marsh Pilot Program Grant