# Self-Management of Continuous Positive Airway Pressure Settings for Veterans with Sleep Apnea

> **NIH VA I01** · VA SAN DIEGO HEALTHCARE SYSTEM · 2020 · —

## Abstract

Background: Because of clinical demands, patients are often under-educated and under-supported about the
features of their positive airway pressure (PAP) devices. The most engaged patients are ones who understand
the details of their device and change the feature settings so that they can maximize the benefits of therapy.
Features settings include humidification level, expiratory pressure relief, pressure ramping, mask alert, auto
pressure start, among other important comfort features. Historically, patients have not been provided with
access to alter or modify therapy pressure settings, which requires physician prescription. Allied medical staff
can carry out subsequent pressure setting changes. It is clear that it is difficult for the healthcare system to
engage in optimal chronic disease management, and accommodate the needs of sleep apnea patients early in
the treatment initialization process, which requires multiple visits/contacts to ensure that patients are
maximizing the use of therapy.
Objectives and Aims: The overarching aim of the proposed project is to examine the effect of providing
patients with the ability to adjust their PAP pressure levels on therapy adherence and outcomes. To answer
these research questions, the proposed randomized, controlled two-group trial of Sleep Apnea Self-
Management Program (SM) and SM plus Individualized Pressure Adjustment (IPA) has the following specific
aims related to APAP adherence and efficacy, patient-reported outcomes, and utilization: (1) To examine the
effect of Individualized Pressure Adjustment (IPA) of settings on treatment adherence and efficacy (i.e., mask
leak and residual apnea-hypopnea index); (2) To examine the effect of SM+IPA versus SM on patient self-
reported treatment outcomes; and (3) To describe the effects of SM-IPA and SM groups on utilization.
Significance: Sleep apnea is one of the most common chronic conditions in the VA. Positive airway pressure
(PAP) therapy is the gold-standard therapy for sleep apnea, but adherence with PAP is suboptimal. VA sleep
programs are understaffed relative to clinical demand for education and support. While adaption to PAP
therapy has traditionally been achieved through sequential visits and pressure changes initiated by providers
during office-based care, self-monitoring and individualized pressure adjustment is an important strategy that
would empower Veterans to achieve better control of their OSA. The key impacts of this project are significant
for both patients (improved outcomes) and the VA (improved staff efficiencies).
Innovation: While patients have control over a wide range of comfort features on their PAP devices,
historically they have not been formally educated and supported to adjust pressure settings. The unique
aspect of this study is the focus on individualizing pressure settings to allow for the maximizing therapeutic
benefit, including increased PAP adherence. Importantly, this is done within the context of provider oversigh...

## Key facts

- **NIH application ID:** 9706638
- **Project number:** 5I01HX002328-02
- **Recipient organization:** VA SAN DIEGO HEALTHCARE SYSTEM
- **Principal Investigator:** Carl J. Stepnowsky
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2020
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2018-05-01 → 2022-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9706638

## Citation

> US National Institutes of Health, RePORTER application 9706638, Self-Management of Continuous Positive Airway Pressure Settings for Veterans with Sleep Apnea (5I01HX002328-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/9706638. Licensed CC0.

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