0469 Efficacy of In-Person vs Telehealth Positive Airway Set-Up in Veterans

Abstract Introduction The SARS-CoV-2 pandemic necessitated a transition to sleep telehealth, including for positive airway pressure (PAP) set up. Prior to this change, the standard of care for initiation of PAP therapy included a face-to-face visit with education. This study sought to evaluate whether telehealth set-up was non-inferior to in-person set-up for veterans initiating PAP therapy. Methods VA patients were identified through prosthetic inventory package orders at two large VA systems. The telehealth PAP set-ups occurred between March, 2020 and December 2021. The in-person PAP set ups occurred between January and December, 2019. PAP data was extracted for days 1-30 (month 1) and 60-90 (month 3). PAP use was compared between in-person and tele-medicine utilizing hours used per night, days used (out of 30 days), and residual AHI (among compliant users). Non-inferiority analyses were performed, using the following non-inferiority margins: 45 minutes for hours used, 4 days for days of usage, and 5 events per hour for residual AHI. Results 432 VA patients (93.5% male) who underwent PAP set up were included (224 in person; 208 telehealth). Average age and BMI (SD) were 55.9±15.8 years and 31.9±5.6. Race and ethnicity identification was 60.7% White; 15.7% Black; 6.9% Asian and 15.5% Hispanic/Latino. 76.2% of participants resided in urban locations. Non-inferiority was established for PAP usage at month 1 (90% CI=-0.31,0.53) and month 3 (90% CI=-0.18, 0.71), days used at month 1 (90% CI=-2.28, 1.33) and month 3 (90% CI=-1.75, 2.20), and residual AHI at month 1 (90% CI=-0.40, 1.62) and month 3 (90% CI=-0.69, 2.30). Conclusion Initiation of PAP therapy via telehealth was non-inferior to in-person set up visits in terms of PAP adherence among Veterans who use VA care. Findings suggest that veteran preference and structural factors should be considered in determining which approach is most appropriate for a given patient. Support (if any) VA Office of Connected Care QI; VA HSR&D RCS-20-191 and NIH/NHLBI K24HL143055 (Martin).