OSA treatment history in an upper airway stimulation trial cohort

Objectives Analyze the obstructive sleep apnea (OSA) treatment history in a group of participants who enrolled in a hypoglossal nerve stimulation trial. Methods Moderate‐severe OSA patients with difficulty adhering to CPAP presented for enrollment in a multicenter trial. Self‐reported history on prior OSA medical therapy was collected at enrollment, including OSA diagnosis date, CPAP start and stop dates, oral appliance trial, and reasons for discontinuation or non‐adherence. Results The cohort consisted of 929 participants, 83% male, with a mean age (53.9 ± 10.5) years. Ninety percent ( n  = 835) had complete CPAP information including 47% ( n  = 435) who discontinued therapy prior to enrollment and 43% ( n  = 400) who were still attempting CPAP but had inadequate adherence. Abandonment rates were 60% at 1‐year, 73% at 3‐years, and 86% at 5‐years. Oral appliance therapy was attempted by 171 patients for mean (1.8 ± 2.3) years, with 81% abandonment at 1 year, 89% at 3‐years, and 94% at 5‐years. Conclusions In this CPAP‐refractory cohort, high rates of CPAP abandonment were reported in the first several years with approximately half of the participants not receiving any treatment despite being diagnosed for >5 years. Close clinical follow‐up and consideration of alternative treatment options is indicated in all OSA patients in order to ensure adequate longitudinal care.