Compassionate CPAP Service
2022 Community Sleep Health and Public Awareness Grant
Vivian Asare, MD
Yale University
Key Project Outcome
Patients who are uninsured and underinsured who cannot afford CPAP machines were identified in our Sleep Clinic and referred to our Compassionate CPAP Service. Patient names, baseline Epworth scores and symptoms were recorded and discussions about the Compassionate CPAP Service took place prior to enrollment. A total of 28 patients were identified, enrolled and a total of 27 CPAP machines and 1 BPAP machine were distributed to these patients. After on-site set up by a local DME company, each patient received a 2-week follow up call by our respiratory therapist to check in, evaluate progress with therapy, and to help with any needed trouble shooting. After the initial 2-week phone call, patients were scheduled for a 30-day telemedicine follow-up visit, and then a subsequent 3-month telemedicine follow-up visit. During these telemedicine clinic visits, discussions about CPAP adherence and tolerance, review of the most recent CPAP data download, and clinical assessment of symptoms post therapy were recorded.
Compliance rates within 3 months, as measured by 70% of nights used for at least 4 hours was 53% which is similar to national CPAP compliance rates, , which range from 30-60%.4. All patients who were compliant with CPAP therapy reported subjective improvement of daytime sleepiness and objective screening supported this finding with lower overall Epworth sleepiness scores post therapy. The average ESS prior to therapy was found to be 10.8 and post therapy was 6.9. The therapeutic success rate, measured by a residual AHI < 5 on data download was found to be 94%.
Patients who were set up on CPAP or BPAP machines through the program, followed up, and reported nightly use of CPAP were found to have improved Epworth sleepiness scale scores compared to their baseline at the initial consult and also reported improvement of symptoms ranging from daytime fatigue to fewer awakenings at night. All patients except one had a residual AHI of less than 5 on their PAP data download.
In conclusion, uninsured patients who were provided free CPAP machines and supplies through the AASM Community Sleep Health Grant were found to have similar compliance rates to national averages to PAP therapy, reported significant improvement of daytime sleepiness, a decrease in Epworth sleepiness scores at follow up visits, and therapeutic control of apneas (residual AHI <5 on data downloads).