Clinical Implementation of a Program to Improve PAP Treatment of Sleep Disordered Breathing Among Veterans

2019 Focused Projects Grant for Junior Investigators

Monica Kelly, PhD
VA Greater Los Angeles Healthcare System, Los Angeles Veterans Research and Education Foundation

Key Project Outcomes

This project involved the development of positive airway pressure. Introductory session handouts and a 1-week follow-up call provider troubleshooting guide termed PREP (PAP Readiness and Education Program). The implementation of PREP within a sleep medicine clinic demonstrated that the program was well-received by patients with newly diagnosed sleep apnea and resulted in PAP acceptance by over one half of individuals in the first week and by nearly two-thirds of individuals in the first month post-PAP initiation. Individuals who participated in PREP had significantly more days of PAP use in the first week and first month after receiving their PAP than did individuals who declined to participate in PREP. These data are promising in conjunction with past studies that have demonstrated that use of PAP during the first week predicts long-term use. Additionally, feedback from PREP participants demonstrated that individuals with newly diagnosed sleep apnea who are prescribed PAP therapy perceived benefits from PREP stemming from increases in knowledge about apnea and PAP and clinician support, and would also prefer to have an element of peer support included in future iterations of the PREP program. PREP participants also highlighted motivators for use including health, family, longevity, and service to others. Common barriers at 1-week follow-up included poor mask fit, nasal congestion, and travel as playing a role in their PAP use. These motivators and barriers to use should be addressed by providers completing follow-up sessions with individuals who are novice PAP users.