0615 Improving Positive Airway Pressure Therapy Compliance in the Military Through Nurse Led Adherence Program

Abstract Introduction Positive Airway Pressure (PAP) is the primary therapy for obstructive sleep apnea (OSA), especially in moderate to severe OSA. Proactive outreach, education, and adequate follow-up have been shown to improve adherence in the civilian population but have not been extensively studied in the military where adherence is historically poor. Studies have cited around 20% meeting Medicare adherence standards in military populations. This improvement project implemented a nurse-led PAP adherence program to improve PAP adherence by 10% after 6 months. Methods Patients with a new diagnosis of moderate to severe OSA were brought to a group session and given education on OSA diagnosis and PAP therapy, which is typical at our sleep center. For this quality improvement project, our nursing team implemented follow-up with patients one week after the group session to ensure they received their PAP machine and scheduled a one-month follow-up through either an in-person or a telehealth appointment (patient preference) with the nursing team. Follow-up appointments evaluated/treated adherence difficulties and set up 3-month and 6-month interval follow ups. Results Demographics and clinical characteristics of the pre-intervention group (n=40) were age 33.8 years, 75% male, apnea-hypoxia index 25.4/hr, body mass index (BMI) 31.0 kg/m2, Epworth sleepiness score (ESS) 12.6, insomnia severity index (ISI) 16.8, low arousal threshold (LAT) endotype 77.5%, and comorbid insomnia in 62.5%. The post-intervention group (n=17) demographics and clinical characteristics were age 35.3 years, 94.1% males, average AHI 46.1/hr, BMI 35.3 kg/m2, ESS 11.8, ISI 16.2, LAT endotype 70.6%, and comorbid insomnia 76.5%. The pre-intervention group showed 77.5% (n=31) with any PAP usage, and 27.5% (n=11) met Medicare adherence requirements over a consecutive 30-day period. To date, the post-intervention group showed 70.6% (n=13) with any PAP usage and 29.4% (n=5) met Medicare adherence. Conclusion Preliminary data showed that the nurse-led intervention adherence program had minimal impact on improving PAP adherence and that overall rates of PAP adherence were poor in our population. Data also showed high rates of hyperarousal states in this population, which could be contributing to poor adherence. Future improvement projects and studies should explore novel approaches to improve PAP adherence among military members with OSA. Support (if any)