Moving the HME Industry Forward


New Algorithm Improves PAP Therapy for Women

May 26, 2014

SAN DIEGO – A new study presented last week at the American Thoracic Society 2014 International Conference (Abstract #714) indicates that a new algorithm, developed specifically for how female sleep apnea sufferers breathe, can improve flow limitation and enable lower pressures for therapy, leading to a more comfortable therapy experience.

The new approach to APAP treatment addresses female-specific obstructive sleep apnea characteristics. Nigel McArdle, MD, consultant physician and research scientist at the West Australian Sleep Disorders Research Institute, Sir Charles Gairdner Hospital, served as lead investigator on the trial and presented the findings from the study, funded by ResMed (Booth #1317 at Medtrade, scheduled for Oct 20-23, 2014, at the Georgia World Congress Center in Atlanta).

The study findings have the potential to better inform treatment decisions, improve therapy experiences, and increase compliance among women with sleep apnea, according to McArdle.

“We’ve known for a while that sleep apnea presents itself differently in men and women, and that physiological gender differences affect treatment responses,” said McArdle. “With that in mind, we designed this trial, the first of its kind, to investigate the possibility of a new treatment algorithm to make APAP therapy more effective and comfortable for women with sleep apnea.”

Using the principles of APAP therapy, researchers at the University of Western Australia, the Western Australian Sleep Disorders Research Institute, and the ResMed Science Centre developed the new treatment algorithm to proactively address female-specific characteristics of sleep apnea.

The algorithm has been designed to reflect the fact that respiratory events in women are typically shorter in duration, that female apneas occur mainly in the rapid eye movement phase of sleep, and that air flow is frequently constrained but not altogether blocked in female patients.

Researchers found that the proportion of flow-limited breaths was significantly lower with the new algorithm than with standard APAP, and mean mask pressure tended to be less.

“The overlooked gender differences of sleep apnea can make treatment uncomfortable and less effective for women,” said Jeff Armitstead, PhD, vice president of Medical Affairs San Diego-based ResMed. “As we learn more about the condition and seek to improve ways to treat it, gender-specific approaches are an obvious next step, and are in line with ResMed’s history of innovative, patient-centric solutions. We’ll continue to support research in this area and seek to translate the knowledge gained into effective therapies.”

Umbian Boasts Compliance Gains with U-Sleep Management Solution
SAN DIEGO – Umbian Inc, a ResMed company and provider of cloud-based healthcare compliance solutions, released study results last week that show measurable efficiency gains when using the automated messaging capabilities of its U-Sleep compliance management solution.

The study, funded by ResMed, revealed a 59% reduction in labor associated with intervening with and coaching patients on CPAP therapy when using U-Sleep. The study was presented this week at the American Thoracic Society (ATS) 2014 International Conference in San Diego by lead investigator Dominic Munafo, MD, DABSM, medical director, Sleep Data Inc, and was supported by Umbian and ResMed.

“This is an opportunity for home medical equipment (HME) providers to redesign the way they interact with patients to improve efficiency, and therefore their bottom line,” said Raj Sodhi, president of Umbian. “Every HME is under pressure to minimize the costs associated with gaining compliance, and these findings show that U-Sleep’s automated messaging can help significantly.”

The goal of the study was to compare the effectiveness and coaching labor requirements of a web-based, automated messaging (via U-Sleep) with standard-of-care CPAP adherence coaching, and measure the coaching labor necessary to achieve Medicare-defined adherence. A secure and flexible compliance solution, U-Sleep monitors CPAP device usage and helps HMEs coach and manage their patients during therapy.

To evaluate the effect of automated messaging on coaching labor and patient adherence, researchers conducted a multi-center, prospective trial of patients newly diagnosed with obstructive sleep apnea. A total of 122 patients completed the three-month study follow-up, with 58 in the U-Sleep arm and 64 in the standard-of-care arm. All patients were set up on a CPAP device with heated humidification and a ResMed wireless modem, and both groups received identical CPAP education and orientation.

The U-Sleep arm received an automated series of text messages and/or emails triggered by one of five situations that indicated non-compliance, such as No CPAP data for two consecutive days or CPAP usage of less than four hours for three consecutive nights. In contrast, the standard-of-care arm received scheduled telephone calls on days one, seven, 14, and 30.

The results of the study reveal a significant reduction in the mean number of minutes of adherence coaching required per patient for the U-Sleep arm, equating to a 59 percent reduction in labor. In addition, there was an observed difference of +10 percent in Medicare-defined adherence for the U-Sleep group (83 vs. 73 percent). Medicare-defined adherence is the documented use of CPAP therapy for at least four hours per night for 70 percent or more nights during a consecutive 30-day period within the first 90 days of therapy.

As the number of people using CPAP therapy to treat sleep apnea increases, the ability to efficiently and effectively monitor and manage CPAP therapy becomes a critical aspect of healthcare. “Scaling to meet the growing sleep apnea patient base requires new ways of thinking for HMEs,” said Sodhi. “Using automated messaging technology to keep patients on track with therapy has the potential to increase an HME’s patient base capacity, and improve a growing number of lives.”

Sleep Apnea Claims Among Veterans on the Rise
WASHINGTON, DC – The military appears to be mirroring civilian society with sleep apnea claims on the rise. According to USA Today, sleep apnea claims have spiked almost 150% since 2009, with government data estimates of about $1 billion per year in costs.

Reporter Tom Vanden Brook writes that nearly nine of 10 veterans receiving compensation are considered 50% disabled by the condition, in which breathing ceases during sleep. For a single veteran without dependents, the monthly payment is $822.15 for a disability rating of 50%.

Veterans Affairs officials attribute the surge in claims — more than 94% of them from veterans of Gulf War I or the Afghanistan and Iraq wars — to greater awareness of the condition. “Sleep apnea has become more and more known as a disease,” said Bradley Flohr, senior adviser for compensation service at the Veterans Benefits Administration in the article. “It can be quite severe. You can die from it.”

USA TODAY first reported on rising sleep apnea claims in June 2010, when only 63,118 veterans were receiving benefits for the condition. “Veterans with sleep apnea are considered by the Department of Veterans affairs to be 50% disabled if they need a Continuous Positive Airway Pressure (CPAP) machine to get a good night’s sleep,” writes Vanden Brook. “The machine and mask increase air pressure in the throat to prevent the airway from collapsing. It eliminates virtually all symptoms of sleep apnea for most people although it is not a cure, said Michael Twery, director of the National Center on Sleep Disorders Research at the National Institutes of Health. Many find the mask uncomfortable to wear.”

Several sleep-related exhibitors will be on display at Medtrade, scheduled for Oct 20-23, 2014, at the Georgia World Congress Center in Atlanta. Early registration begins on Monday, June 16. Watch Medtrade Monday for additional details. For more information, visit