1194 Improving CPAP Adherence Through Mask Fit Optimization: A Quality Improvement Initiative in the Outpatient Sleep Clinic

Abstract Introduction Continuous Positive Airway Pressure (CPAP) is the standard treatment for obstructive sleep apnea (OSA), yet adherence remains suboptimal and mask problems may limit patient use. We created a mask-fit clinic to address this issue, but its value is unclear. We initiated a quality improvement project to evaluate the impact of this clinic on improving CPAP adherence. Methods We initiated a mask-fit clinic at two sleep clinics. Adult patients with OSA who report mask discomfort or adherence difficulties specifically due to mask issues are referred by their sleep provider for an individualized mask-fit evaluation which consists of a structured 60-minute, in- person session conducted by a sleep technologist and nurse practitioner. Multiple mask styles are presented and trialed based on patient complaints. Once a preferred mask is selected, the patient is evaluated wearing the mask with CPAP at pressure to facilitate acclimation and allow further troubleshooting. The value of this session was assessed by comparing CPAP adherence in the two weeks prior and two weeks following the mask-fit session based on data downloads. Results To date, 27 participants (mean age 62 ± 15 yrs, 56% female, 74% White) attended the mask-fit clinic. Mean apnea hypopnea index (AHI) was 32 ± 20 events/hr. Patients had been using CPAP for a median of 16 months (IQR [3, 56]). The mask was changed to a new style in 20 patients (74%), changed to a new size in 4 patients (15%), and not changed in 3 patients (11%). Mean adherence increased by 17 minutes from 287 ± 29 min to 304 ± 27 min, though this difference was not statistically significant (p=0.45). No change in mean leak was observed (28 ± 7 L/min to 29 ± 5 L/min. p=0.88). Conclusion Preliminary findings suggest that a structured, in-person mask fitting session may increase CPAP adherence by optimizing mask comfort. Ongoing data collection and a larger sample size will allow for a more precise assessment of the benefits of this intervention. Support (if any)