Ryan J Soose1, Matheus Araujo2, Kevin Faber3, Asim Roy4, Kent Lee5, Quan Ni5, Jaideep Srivastava2, Patrick J Strollo6. 1. University of Pittsburgh, UPMC Department of Otolaryngology, Pittsburgh, PA, U.S. 2. University of Minnesota, Department of Computer Science and Engineering, Minneapolis, MN, U.S. 3. Sanford Health, Sleep Medicine, Fargo, ND, U.S. 4. Ohio Sleep Medicine Institute, Columbus, OH, U.S. 5. Inspire Medical Systems, Golden Valley, MN, U.S. 6. University of Pittsburgh, UPMC Division of Pulmonary Allergy and Critical Care Medicine, Pittsburgh, PA, U.S.
Abstract
STUDY OBJECTIVES: Upper airway stimulation (UAS) therapy is effective for a subset of obstructive sleep apnea (OSA) patients with continuous positive airway pressure (CPAP) intolerance. While overall adherence is high, some patients have suboptimal adherence, which limits efficacy. Our goal was to identify therapy usage patterns during the first three months of therapy to enable targeted strategies for improved adherence. METHODS: Therapy data was retrieved from 2,098 patients for three months after device activation. Data included mean and standard deviation (SD) of hours of use, therapy pauses, hours from midnight the therapy was turned ON and OFF, percentage of missing days, and stimulation amplitude. Cluster analysis was performed using Gaussian mixture models that categorized patients into six main groups. RESULTS: The six groups and their prevalence can be summarized as Cluster 1A: Excellent Use (34%); Cluster 1B: Excellent Use with variable timing (23%); Cluster 2A: Good Use with missing days and late therapy ON (16%), Cluster 2B: Good Use with missing days, late therapy ON, and early therapy OFF (12%); Cluster 3A: Variable Use with frequent missing days (8%); Cluster 3B: Variable Use with frequent pauses (7%). Most patients (85%) are excellent or good users with mean therapy use >6 hours per night. CONCLUSIONS: Cluster analysis of early UAS usage patterns identified six distinct groups that may enable personalized interventions for improved long-term management. Differentiation of the patient clusters may have clinical implications with regard to sleep hygiene education, therapy discomfort, comorbid insomnia, and other conditions that impact adherence.
STUDY OBJECTIVES: Upper airway stimulation (UAS) therapy is effective for a subset of obstructive sleep apnea (OSA) patients with continuous positive airway pressure (CPAP) intolerance. While overall adherence is high, some patients have suboptimal adherence, which limits efficacy. Our goal was to identify therapy usage patterns during the first three months of therapy to enable targeted strategies for improved adherence. METHODS: Therapy data was retrieved from 2,098 patients for three months after device activation. Data included mean and standard deviation (SD) of hours of use, therapy pauses, hours from midnight the therapy was turned ON and OFF, percentage of missing days, and stimulation amplitude. Cluster analysis was performed using Gaussian mixture models that categorized patients into six main groups. RESULTS: The six groups and their prevalence can be summarized as Cluster 1A: Excellent Use (34%); Cluster 1B: Excellent Use with variable timing (23%); Cluster 2A: Good Use with missing days and late therapy ON (16%), Cluster 2B: Good Use with missing days, late therapy ON, and early therapy OFF (12%); Cluster 3A: Variable Use with frequent missing days (8%); Cluster 3B: Variable Use with frequent pauses (7%). Most patients (85%) are excellent or good users with mean therapy use >6 hours per night. CONCLUSIONS: Cluster analysis of early UAS usage patterns identified six distinct groups that may enable personalized interventions for improved long-term management. Differentiation of the patient clusters may have clinical implications with regard to sleep hygiene education, therapy discomfort, comorbid insomnia, and other conditions that impact adherence.
Authors: Faith S Luyster; Quan Ni; Kent Lee; Christine Harrison; Vaibhav H Ramprasad; Ryan J Soose; Patrick J Strollo Journal: J Clin Sleep Med Date: 2022-09-01 Impact factor: 4.324