Social Factors Associated with CPAP Acceptance

Abstract

The investigators conducted a cross-sectional study of consecutive patients offered treatment with CPAP for OSA, and found that SES influenced acceptance of CPAP therapy. The report raises important questions about how we present CPAP to patients from different SES backgrounds. Simon-Tuval et al. report on 162 consecutive patients with moderate-severe OSA. The investigative team employed a CPAP support system to introduce CPAP and initiate its uptake among patients. The system consisted of full-night polysom-nography, an additional titration study, meetings with sleep specialists, education about the pathophysiology of OSA and the benefits of CPAP, encouragement to take part in a 2-week adaptation program and extensive support around choosing the proper device and interface. Patients were told up front that they were likely responsible for the cost of 30% of their CPAP device under the healthcare system most commonly seen in this clinic. Only 40% of those being recommended for CPAP accepted the treatment. Accepters of CPAP were older, had higher incomes, had more severe apnea, had no bed partner, and were more likely to have heard about positive CPAP experiences from family and friends. These findings were evident even after controlling for key variables (age, BMI, subjective sleepiness, and AHI). The authors conclude that low SES patients are "less receptive to CPAP treatment," and that programs should be geared toward these individuals.