0605 Early Identification of Common PAP-Associated Problems: Evaluation of the PAP Issue Stratification Tool (PIST)

Abstract Introduction Treatment-related problems during early positive airway pressure therapy (PAP) create adherence barriers. We evaluated the factor structure of a brief screening tool for common PAP problems, determined a scoring approach, and assessed predictive validity for non-adherence to support PAP troubleshooting. Methods A one-group, prospective observational design at Kaiser Permanente Southern California consecutively enrolled PAP-naïve adults with moderate-severe OSA (AHI4%≥15) who accepted PAP (autoCPAP). A PAP Issue Stratification Tool (PIST) survey (content validated by patient and sleep clinician panels) included 32 common PAP issues rated on a 4-point Likert scale for the question, “how much does each issue bother you?” Patients who used PAP≥30 minutes on ≥2 of first 5 days received a survey link on treatment day 5, 10, and 30. Objective PAP use was collected for days 1-90. Exploratory factor analysis (promax) informed domain structure and scoring. PIST total and domain scores were calculated on a 0-100 scale, with higher scores indicating more bothersome issues. Using Day 10 PIST responses, we compared total and domain scores between adherers and non-adherers for usage intervals Days 1-30, 1-90, 61-90 using t-tests (adherence: ≥4 hours/night on ≥70% of days). Results Of 306 eligible patients, 216 completed Day 10 PIST. Thirteen items had ≥70% endorsement of “not at all”; four items were removed for low communality or overlapping clinical constructs. Cronbach r=0.90. Factor analysis included 27 items with 59% of variance explained by 5 factors: (1) mask-related symptoms and distress, (2) sleep disturbances, (3) psychosocial and practical burdens, (4) device-related challenges, and (5) physiological side effects. For t-tests, 211 participants were included (>2 items incomplete, removed [n=5]). PAP adherence rates were: 59% (Days 1-30); 50% (Days 1-90); 46% (Days 61-90). Total PIST score and domain 1 scores were higher for non-adherers at all outcome intervals (p<.001). Domain 2 and 4 scores were higher for non-adherers for Days 1-30 and Days 1-90 (p<.05). Domain 3 was higher at Day 1-90 (p<.05). Conclusion The 27-item PIST is a valid screening instrument for identifying clinical PAP issues. Early identification of mask-related symptoms, sleep disturbances, and device-related challenges may inform targeted interventions to improve PAP adherence. Support (if any)