• Sanjay R Patel, Jessie P Bakker, Christy J Stitt, Mark S Aloia, and S Mehdi Nouraie.
• Center for Sleep and Cardiovascular Outcomes Research, University of Pittsburgh, Pittsburgh, PA; Division of Pulmonary Allergy and Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA. Electronic address: patelsr2@upmc.edu.
• Chest. 2021 Jan 1; 159 (1): 382-389.

BackgroundCPAP effectiveness is limited by suboptimal adherence. Prior studies of adherence have focused on middle-aged men.Research QuestionDoes CPAP adherence vary by age and sex?Study Design And MethodsTelemonitoring data from a CPAP manufacturer database were used to assess adherence in patients initiating CPAP therapy between November 2015 and October 2018. Analyses were restricted to patients in the United States aged 18 to 90 years.ResultsAcross 789,260 patients initiated on CPAP (mean age, 55 ± 14 years; 58.2% male), overall adherence by US Centers of Medicare & Medicaid Services criteria was 72.6%, but it varied dramatically by age and sex, ranging from 51.3% in 18- to 30-year-old women to 80.6% in 71- to 80-year-old men. Patterns of use over the first 90 days demonstrated that younger age groups had peak CPAP use by the 2nd night, with a subsequent decay in use, including abandonment of CPAP, which was greatest among 18- to 30-year-old women. In contrast, older patients steadily increase use, taking more than a week to maximize usage, and then they have much slower decays in use over time. Younger, but not older, patients have lower use of CPAP on weekends compared with weekday nights.InterpretationCPAP adherence rates vary substantially by demographics, with 18- to 30-year-old women having the lowest adherence. The pattern of use over the first 90 days also varies substantially by age and sex. Further research to understand and address the causes of disparities will be crucial to maximizing the benefits of CPAP therapy.Copyright © 2020 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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