Access to CPAP treatment in patients with moderate to severe sleep apnea in a Latin American City

Juan Facundo Nogueira; Guido Simonelli; Vanina Giovini; María Florencia Angellotti; Eduardo Borsini; Glenda Ernst; Carlos Nigro

doi:10.5935/1984-0063.20180032

Sleep Science, Table of Contents

CC BY-NC-ND 4.0 · Sleep Sci 2018; 11(03): 174-182
DOI: 10.5935/1984-0063.20180032

ORIGINAL ARTICLE

Access to CPAP treatment in patients with moderate to severe sleep apnea in a Latin American City

Authors

Juan Facundo Nogueira

¹Instituto Argentino de Investigación Neurológica, Sleep Laboratory - Buenos Aires - Ciudad Autonoma de Buenos Aires - Argentina.

²Hospital de Clínicas, University of Buenos Aires, Sleep Laboratory - Buenos Aires - Ciudad Autonoma de Buenos Aires - Argentina.

³Grupo Argentino de Investigación en Apneas del Sueño, Cooperative Group of Research - Buenos Aires - Ciudad Autonoma de Buenos Aires - Argentina.
Guido Simonelli

³Grupo Argentino de Investigación en Apneas del Sueño, Cooperative Group of Research - Buenos Aires - Ciudad Autonoma de Buenos Aires - Argentina.

⁴Walter Reed Army Institute of Research, Behavioral Biology Branch - Silver Spring - Maryland - United States.
Vanina Giovini

²Hospital de Clínicas, University of Buenos Aires, Sleep Laboratory - Buenos Aires - Ciudad Autonoma de Buenos Aires - Argentina.

³Grupo Argentino de Investigación en Apneas del Sueño, Cooperative Group of Research - Buenos Aires - Ciudad Autonoma de Buenos Aires - Argentina.
María Florencia Angellotti

¹Instituto Argentino de Investigación Neurológica, Sleep Laboratory - Buenos Aires - Ciudad Autonoma de Buenos Aires - Argentina.

²Hospital de Clínicas, University of Buenos Aires, Sleep Laboratory - Buenos Aires - Ciudad Autonoma de Buenos Aires - Argentina.

³Grupo Argentino de Investigación en Apneas del Sueño, Cooperative Group of Research - Buenos Aires - Ciudad Autonoma de Buenos Aires - Argentina.
Eduardo Borsini

³Grupo Argentino de Investigación en Apneas del Sueño, Cooperative Group of Research - Buenos Aires - Ciudad Autonoma de Buenos Aires - Argentina.
Glenda Ernst

³Grupo Argentino de Investigación en Apneas del Sueño, Cooperative Group of Research - Buenos Aires - Ciudad Autonoma de Buenos Aires - Argentina.
Carlos Nigro

³Grupo Argentino de Investigación en Apneas del Sueño, Cooperative Group of Research - Buenos Aires - Ciudad Autonoma de Buenos Aires - Argentina.

Abstract

Introduction: The most effective treatment for moderate to severe obstructive sleep apnea (OSA) is continuous positive airway pressure (CPAP) but adherence may be a limiting factor. Most compliance studies often only include patients under CPAP treatment, neglecting the importance of access to treatment. The aim of this study was to evaluate CPAP access and compliance in OSA patients, after CPAP indication and titration.

Methods: We included moderate to severe OSA patients, diagnosed by in-lab polysomnography (PSG), with CPAP indication and effective pressure titration. Between 12 to 18 months after treatment was indicated a telephone questionnaire was administered including questions about access to CPAP, reasons of no access, reported adherence and symptoms improvement.

Results: A total of 213 patients responded to the survey (171 males, mean age 53.4±13.5 and BMI 34.02±8.8 kg/m²). Almost a third of the patients (28.2%) did not initiate CPAP treatment. Out of 213, 153 patients (71.8%) started treatment with CPAP and 120 (56.3%) reported still being under treatment a year after indication, additionally, 85.8% reported that they were using it =4hs/night. Those who accessed to CPAP were on average, older age, had full coverage of treatment by their medical insurance, required lower effective pressure and experienced more severe sleepiness compared to those individuals who did not accessed to CPAP.

Discussion: A significant proportion of OSA patients with CPAP indication did not initiate and/or eventually abandoned CPAP. Approximately only 50% of the patients were still under treatment, with acceptable self-reported adherence rate and clinical response, one year after the initial treatment indication. Additional measures are necessary to increase access to CPAP and improve long-term compliance.

Sleep Apnea - Obstructive - Continuous Positive Airway Pressure - Compliance - Education

Full Text

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