New research challenges the 90-day CPAP compliance policy.
Key takeaways:
- A study of over 132,000 patients found that early struggles with CPAP therapy do not equate to long-term treatment failure.
- More than one-third of patients who failed to meet Medicare’s 90-day adherence criteria were still using their devices a year later.
- Researchers suggest policymakers and clinicians should reconsider relying solely on arbitrary early-use thresholds for long-term treatment decisions.
Many insurers stop covering CPAP devices if patients do not use them regularly in the first 90 days. But new research presented at the ATS 2026 International Conference shows that many patients who initially struggle to meet these early-use thresholds do go on to use and benefit from CPAP therapy.
For the study, researchers analyzed data on more than 132,000 patients treated for obstructive sleep apnea (OSA) within Kaiser Permanente Southern California, a system that offers CPAPs to patients regardless of whether they meet the early-use threshold.
The findings challenge long-held assumptions that poor early use predicts long-term CPAP use. These assumptions serve as the basis for a Medicare policy that requires patients with OSA to use their CPAP for at least four hours each night on 70% of nights during a 30-day window within the first 90 days to maintain coverage. This means patients who would ultimately benefit from CPAP may lose access to effective treatment.
“Our findings suggest clinicians and policymakers should not rely solely on Medicare-defined adherence, given its reliance on early CPAP use and an arbitrary four-hour threshold, when making long-term treatment decisions,” says first author Dennis Hwang, MD, a sleep and pulmonary physician at Kaiser Permanente Southern California, in a release. “Extending support and coverage beyond the first 90 days could help more patients achieve meaningful benefit.”
Researchers found that 51% of patients did not meet the 90-day Medicare criteria for continued use. However, more than one-third of patients who missed the early Medicare use criteria were still using CPAP one year later. Importantly, even those who were not meeting the four-hour threshold were still using the devices for at least two hours a night, an amount known to improve symptoms of sleep apnea.
The results suggest that early nonadherence does not equate to treatment failure.
“These findings challenge a long-standing assumption in clinical practice and policy,” says Hwang in a release. “While clinicians know some patients take time to adapt, the scale of continued use we observed in those that did not initially meet Medicare adherence was striking.”
Next, researchers are planning additional studies to better understand which patients are most likely to become long-term CPAP users and evaluate evidence-based coverage policies that focus on patient outcomes rather than arbitrary usage thresholds.
