Barry Krakow, M.D.1,2,3; Victor Ulibarri, B.S.1,2; Dominic Melendrez, B.S.1,2; Shara Kikta2; Laura Togami2; Patricia Haynes, Ph.D.4
1Sleep & Human Health Institute, Albuquerque, NM; 2Maimonides Sleep Arts & Sciences, Ltd, Albuquerque, NM; 3Los Alamos Medical Center Sleep Laboratory, Los Alamos, NM;4Department of Psychiatry, University of Arizona, Tucson, AZ
To assess the impact of a daytime sleep medical procedure–the PAP-NAP–on adherence to positive airway pressure (PAP) therapy among insomnia patients with sleep disordered breathing (SDB)
The PAP-NAP is based on Current Procedural Terminology (CPT) codes and combines psychological and physiological treatments into one procedure, which increases contact time between SDB patients and polysomnography technologists to enhance PAP therapy adherence. Using a Sleep Dynamic Therapy framework, explicating SDB as a mind-body disorder, the PAP-NAP includes mask and pressure desensitization, emotion-focused therapy to overcome aversive emotional reactions, mental imagery to divert patient attention from mask or pressure sensations, and physiological exposure to PAP therapy during a 100-minute nap period. Patients treated with the PAPNAP test (n=”39)” were compared to an historical control group (n=”60)” of insomnia patients with SDB who did not receive the test.
All 99 insomnia patients were diagnosed with SDB (mean AHI 26.5 + 26.3, mean RDI 49.0 + 24.9), and all reported a history of psychiatric disorders or symptoms as well as resistance to PAP therapy. Among 39 patients completing the PAP-NAP, 90% completed overnight titrations, compared with 63% in the historical control group; 85% of the nap-tested group filled PAP therapy prescriptions for home use compared with 35% of controls; and 67% of the nap-tested group maintained regular use of PAP therapy compared with 23% of the control group. Using standards from the field of sleep medicine, the nap-tested group demonstrated objective adherence of 49% to 56% compared to 12% to 17% among controls. All studies were reimbursed using CPT 95807-52.
In this pilot study, the PAP-NAP functioned as a brief, useful, reimbursable procedure to encourage adherence in insomnia patients with SDB in comparison to an historical control group that did not undergo the procedure.
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