Determinants affecting initiation of continuous positive airway pressure treatment.
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.
Brin
Yaron S
YS
Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
Reuveni
Haim
H
Greenberg
Sari
S
Tal
Asher
A
Tarasiuk
Ariel
A
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