0681 Impact of Sinonasal Optimization and Structured Coaching on 90-Day CPAP Adherence in Patients with Obstructive Sleep Apnea

Abstract Introduction CPAP therapy remains the gold standard for treating OSA. Unfortunately, many patients struggle with CPAP adherence. Frequently, patients have only 90 days to meet criteria for adherence to assure coverage. This study evaluated the effectiveness of a comprehensive nasal airway evaluation and appropriate minimally invasive sinonasal surgery coupled with comprehensive CPAP coaching on Medicare CPAP adherence. Methods This was a retrospective study of 2700 patients diagnosed with OSA (AHI ≥ 5) who underwent sinonasal evaluation and CPAP treatment between April 2023 and August 2025 from a multi-state ENT practice. Physicians performed thorough sleep and sinonasal evaluation consisting of an in-depth history, physical examination, sinonasal imaging, and endoscopy. When clinically appropriate, patients were offered minimally invasive procedures—including balloon sinuplasty and extensive turbinate and swell body reduction—to improve nasal and sinus patency prior to CPAP initiation. All patients began therapy with an APAP machine and were enrolled in a proprietary exception management coaching program, Clarity™. Non-adherent patients were contacted via email and/or text on days 3, 10, 20, 45, 60 and 80 to troubleshoot and resolve patient difficulties. Coaching calls were performed by respiratory therapists or registered polysomnographic technicians. The primary endpoint was Medicare adherence at 90 days. Results Medicare CPAP adherence was 84.4% at 90 days. Patients were 77% male, age 52.0 ± 12.4, BMI 35.4 ± 7.0, AHI 42.8 ± 24.9 (mean ± SD). OSA severity based on Chicago criteria was 11% mild, 23% moderate, and 66% severe. Adherence by severity was 81%, 83%, and 85% respectively. Mask choice was 57% nasal pillows, 31% nasal mask and 11% full face mask. Adherence by mask type was 84%, 86%, and 84% respectively. Adherence by sex was male 84% and female 85%. Conclusion CPAP adherence in this cohort was excellent and much better than historically published data. The data suggest that assessing and optimizing nasal anatomy coupled with a comprehensive coaching program can drive improved CPAP adherence. Further research is needed to determine the specific impact of the various minimally invasive surgical procedures. Support (if any)