Weaver TE, Maislin G, Dinges DF, et al. Relationship between hours of CPAP use and achieving normal levels of sleepiness and daily functioning. Sleep 2007;30(6):711–719

Helping with compliance in OSA patients is NOT only essential for obtaining improved outcomes, but CMS and insurers are now requiring documentation of compliance (not just self reported us of an OA -oral appliance) but technology to confirm mask use, etc.

I place a useful link to this topic of adherence and modifiable factors (see Table 1) from Medscape (may need to establish free account to access):

Enhancing Adherence to Positive Airway Pressure Therapy for Sleep Disordered Breathing

Tonya Russell MD

Semin Respir Crit Care Med. 2014;35(5):604-612. 

Table 1. Factors that may affect adherence to PAP therapy and interventions that may improve adherence to PAP therapy

On page 9 of Medscape link is section on subject and objective compliance studies with excellent references.

"Monitoring of Compliance

Compliance with PAP can be monitored both subjectively and objectively. Subjective reports of compliance often result in an over reporting of adherence, and cannot be reliably used to differentiate between compliance and noncompliance.[93] Most PAP devices now have data cards that can be downloaded to provide information regarding use. However, the algorithm for how data are obtained and reported depends on the machine. Therefore, the reported data are not standardized. In general, the data obtained can include date ranges of use, number of nights used and not used, percentage of nights with use, percentage of nights with use ≥ 4 hours or < 4 hours, average use on all nights, and average duration of use on nights when used. The American Thoracic Society (ATS) recently issued a statement regarding CPAP tracking systems. The statement suggests that while the data from downloads are useful, more studies need to be done to clearly demonstrate the impact the data have on patient outcomes. In addition, clinicians need to be aware that the definitions for AHI and excessive mask leak as noted on the download are not standardized and can be difficult to interpret, although the high and low extremes of these variables are helpful in determining factors that may impact adherence.[94]

While the insurance industry standard is to follow the CMS definition of compliance, the authors of the statement recommend that a patient be considered adherent if they are using PAP for more than 2 hours per night and having improvement in daytime functional status, although the patient should be encouraged to use the PAP for the entire sleep time. They also recommend assessing use at 1 week, 4 to 6 weeks, 12 weeks, 6 months, and then annually because the pattern of adherence is often determined early.[94] "

More PAP devices now have a feature allowing data to be downloaded wirelessly. A small pilot study among veterans suggested a trend toward improved adherence in those patients whose use was monitored wirelessly with the data leading to a clinical care pathway to improve adherence versus standard care with a phone call at 1 week and in-office visit at 1 month. Although the difference in use was not statistically significant, the trend suggests a clinically significant difference with 4.1 hours of use per night in the wirelessly monitored group versus 2.8 hours of use in the standard care group.[95] In a second study evaluating the usefulness of wireless download, patients were randomized to standard care with a phone call soon after initiating therapy and an office visit at 4 to 6 weeks compared with daily download of compliance data with contact by a coordinator if certain clinical parameters were met (i.e., high leak, poor use, residual AHI > 10). The wirelessly monitored group had a higher average use of 3.2 hours per night as compared with 1.8 hours per night in the standard care group. On the nights used, the duration of use in the wirelessly monitored group was 5.4 hours as opposed to 3.4 hours in the standard care group

I hope this is useful for you

Best

http://www.medscape.com/viewarticle/834471_3

What OSA patients are?

I need to better understand the question, I'm sorry

. I started a Master of Nursing case - care managers, because I think that only the case management  is not enough to give good quality care.

Thanks Alan for the detailed reply, and your points are well taken. You are correct from CMS perspective and providers it is now a requirement that we have actual data that can be collected from the machine itself for the usage information. Per CMS guidelines, a patient is considered compliant if the patient is using the machine on average of 4 hours or more per night within any consecutive 30 days for 70% of the time. That is where I believe technology can play a pivotal role in keeping case managers , program director and their employees keeping a close eye on patient compliance. One more thing, I do like to point out here that, is about early intervention is being the best solution. Sooner we can find out about the problem a patient may be having , sooner we can intervene to bring the patient back on track. 

Regards,

Asif Kidwai