Redefining Positive Airway Pressure (PAP) Adherence Phenotypes Utilizing Deep Neural Networks and Unsupervised Clustering
Yoav N. Nygate, MS, Sam Rusk, BS, Chris R. Fernandez, MS, Nick Glattard, MS, Nathaniel F. Watson, MD, MSc, William Hevener, RPSGT, Bretton Beine, BS, RPSGT, Dominic Munafo, MD
Improving positive airway pressure (PAP) adherence is crucial to obstructive sleep apnea (OSA) treatment success.
We have previously shown the potential of utilizing Deep Neural Network (DNN) models to accurately predict future PAP usage, based on predefined compliance phenotypes, to enable early patient outreach and interventions. These phenotypes were limited, based solely on usage patterns.
We propose an unsupervised learning methodology for redefining these adherence phenotypes in order to assist with the creation of more precise and personalized patient categorization.
We trained a DNN model to predict PAP compliance based on daily usage patterns, where compliance was defined as the requirement for 4 hours of PAP usage a night on over 70% of the recorded nights.
The DNN model was trained on N=14,000 patients with 455 days of daily PAP usage data. The latent dimension of the trained DNN model was used as a feature vector containing rich usage pattern information content associated with overall PAP compliance.
Along with the 455 days of daily PAP usage data, our dataset included additional patient demographics such as age, sex, apnea-hypopnea index, and BMI. These parameters, along with the extracted usage patterns, were applied together as inputs to an unsupervised clustering algorithm.
The clusters that emerged from the algorithm were then used as indicators for new PAP compliance phenotypes.
Two main clusters emerged: highly compliant and highly non-compliant.
Furthermore, in the transition between the two main clusters, a sparse cluster of struggling patients emerged.
This method allows for the continuous monitoring of patients as they transition from one cluster to the other.
In this research, we have shown that by utilizing historical PAP usage patterns along with additional patient information we can identify PAP specific adherence phenotypes. Clinically, this allows focus of PAP adherence program resources to be targeted early on to patients susceptible to treatment non-adherence.
Furthermore, the transition between the two main phenotypes can also indicate when personalized intervention is necessary to maximize treatment success and outcomes. Lastly, providers can transition patients in the highly non-compliant group more quickly to alternative therapies.