Compliance after switching from CPAP to ASV: big data analysis

Background Compliance with positive airway pressure (PAP) is essential for the benefits of therapy to be realised. This big data analysis investigated 90-day compliance in patients receiving CPAP and/or adaptive servo-ventilation (ASV).

Methods Telemonitoring data were obtained from a US PAP database. Eligible patients were a 30% random sample who started PAP from 1 Jan to 2 Oct 2015. All received PAP with an AirSense/AirCurve 10 device (ResMed) and had ?1 session with use ?1h. Compliance and device usage were determined in 3 patient groups: started on CPAP, stayed on CPAP (CPAP-only); started on ASV, stayed on ASV (ASV-only); switched from CPAP to ASV (switch). Compliance was defined as device use for ?4h on 70% of nights during a consecutive 30-day period anytime during the first 90 days.

Results 198,895 patients were included; 189,724, 8,957 and 214 in the CPAP-only, ASV-only and switch groups. Patients in the ASV-only and switch groups were significantly older than CPAP-only patients. Patients who switched from CPAP to ASV had the highest residual apnea-hypopnea index (AHI) at day 1 (17.41/h vs 3.67/h and 5.30/h in the CPAP-only and ASV-only groups, respectively; p<0.001). This was also the case for AHI at week 1, and average AHI from day 1–90. At 90 days, compliance rates were 73.8% in the CPAP-only group and 73.2% in the ASV-only group. In the switch group, CPAP compliance before the switch was 62.1% but this improved to 74.8% after the switch to ASV.

Conclusion Real-world compliance with PAP over the first 90 days was good. For patients with a high AHI at CPAP initiation, switching to ASV was associated with better compliance, with a rate that was similar to that achieved with single mode therapies.