title: Apnea burden: efficacy versus effectiveness in patients using positive airway pressure.
abstract: BACKGROUND
  Modern continuous positive airway pressure (PAP) machines track hours of use and residual respiratory events while on treatment. A substantial portion of sleep apnea patients are partially compliant, emphasizing the need to distinguish between PAP efficacy and PAP effectiveness in chronic management of patients with sleep apnea.
  
  
  METHODS
  We used a combination of three data sources to estimate the sleep apnea burden in a convenience cohort of PAP users from our clinics that were compliant based on Medicare criteria: self-reported habitual total sleep time, and PAP usage times with residual apnea-hypopnea index (AHI) from compliance downloads.
  
  
  RESULTS
  Assuming that the off-PAP time consists of baseline AHI severity, an estimated apnea burden was calculated to estimate PAP effectiveness. Whereas 70% of patients in our cohort showed machine AHI values <5/h, the apnea burden calculations revealed that only one-third of patients are predicted to have an effective AHI <5.
  
  
  CONCLUSIONS
  Estimating PAP effectiveness through the concept of apnea burden has implications for clinical care as well as research trials.
authors.affiliation: Neurology Department, Massachusetts General Hospital, Boston, USA; Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA. Electronic address: mtbianchi@partners.org.
authors.forename: Matt T
authors.initials: MT
authors.lastname: Bianchi
authors.affiliation: Neurology Department, Massachusetts General Hospital, Boston, USA.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Alameddine
authors.affiliation: Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: James
authors.initials: J
authors.lastname: Mojica
mesh_terms: D000368:Aged; D045422:Continuous Positive Airway Pressure; D017281:Cost of Illness; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D017286:Polysomnography; D012189:Retrospective Studies; D012891:Sleep Apnea Syndromes / Q000628:therapy*; D016896:Treatment Outcome
keywords: Apnea burden; Compliance; Effectiveness; Efficacy; Management