title: Determinants affecting initiation of continuous positive airway pressure treatment.
abstract: BACKGROUND
  Continuous positive airway pressure is the treatment of choice for patients with obstructive sleep apnea syndrome.
  
  
  OBJECTIVE
  To determine the factors influencing treatment initiation with a CPAP device in a healthcare system in which co-payment is required.
  
  
  METHODS
  A total of 400 adult patients with OSAS who required CPAP therapy completed questionnaires at three different stages of the diagnostic and therapeutic process: CPAP titration study (stage 1), patient adaptation trial (stage 2), and purchase of a CPAP device (stage 3). Logistic regression was used to analyze the variables influencing CPAP use at the different stages of the diagnostic and therapeutic processes.
  
  
  RESULTS
  Only 32% of the patients who underwent CPAP titration study purchased a CPAP device. The number of subjects who purchased a CPAP device increased gradually as monthly income increased, 28% vs 62% in the "very low" and "very high" income levels respectively. Reporting for the titration increased in patients with excessive daytime sleepiness and an Epworth Sleepiness Scale score above 9 (odds ratio = 1.9, P = 0.015). Higher socioeconomic status increased reporting to stage 2 (OR = 1.23, P = 0.03) and CPAP purchase (stage 3, OR = 1.35, P = 0.002). Excessive daytime sleepiness increased reporting to stage 2 (OR = 2.28, P = 0.006). Respiratory disturbance index above 35 increased CPAP purchasing (OR = 2.01, P = 0.022). Support from the bed partner, referring physician and sleep laboratory team increased CPAP purchasing.
  
  
  CONCLUSIONS
  A supportive environment for a patient with OSAS requiring CPAP is crucial to increase initiation of CPAP treatment. Minimizing cost sharing for the CPAP device will reduce inequality and may increase CPAP treatment initiation.
authors.affiliation: Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
authors.forename: Yaron S
authors.initials: YS
authors.lastname: Brin
authors.forename: Haim
authors.initials: H
authors.lastname: Reuveni
authors.forename: Sari
authors.initials: S
authors.lastname: Greenberg
authors.forename: Asher
authors.initials: A
authors.lastname: Tal
authors.forename: Ariel
authors.initials: A
authors.lastname: Tarasiuk
mesh_terms: D045422:Continuous Positive Airway Pressure / Q000191:economics / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007398:Interpersonal Relations; D007557:Israel; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D017286:Polysomnography; D012189:Retrospective Studies; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000191:economics / Q000628:therapy*; D012959:Socioeconomic Factors