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Socioeconomic status, race found to impact CPAP compliance



Positive indicators of compliance with continuous positive airway pressure (CPAP) included higher apnea-hypopnea index, white race, and higher median household income, results from a large single-center cohort study showed.

Sleep apnea sufferer being treated by CPAP via mask and air tube from machine. ©David Cannings-Bushell/

“CPAP is the gold standard treatment for OSA [obstructive sleep apnea] and is very effective, especially for those with severe disease,” researchers led by Philip S. LoSavio, MD, wrote in an abstract presented at the Triological Society’s Combined Sections Meeting. “However, CPAP is a significant challenge for patients for various reasons, with reports of only 46%-80% of OSA patients using CPAP for more than 4 consecutive hours on two out of three nights.”

In an effort to identify and define different factors associated with CPAP compliance, Dr. LoSavio and his colleagues collected data on 578 patients with OSA on CPAP who were treated at Rush University Medical Center, Chicago. The mean patient age was 58 years, 52% were female, 43% were African American, 40% were white, their mean body mass index was 36.91 kg/m2, and their mean apnea-hypopnea index was 37.25 events per hour. The researchers recorded CPAP use at office visits via CPAP module or card, and patients were considered CPAP compliant if their machines logged 4 consecutive hours of use for 70% or more of nights. During the office visits, patients completed a questionnaire asking if they were suffering from different otolaryngology-related diseases, including sinus headaches, gastroesophageal reflex, and enlarged tonsils. Dr. LoSavio, who heads the section of sleep surgery in the department of otorhinolaryngology at Rush University Medical Center, and his colleagues performed logistic regression to ascertain the effects of race and socioeconomic status on CPAP compliance while adjusting for OSA severity. They also analyzed the adjusted association of median income and self-reported symptoms of sinus headaches, GERD, and enlarged tonsils, on CPAP compliance.

They found that African American patients were less compliant with CPAP, compared with their white counterparts (OR 0.42; P less than .01). In addition, patients with mild OSA were less likely to be compliant compared with those who had severe disease (OR 0.57; P less than .03). Self-reported symptoms of sinus headaches, GERD, and enlarged tonsils were associated with significantly lower levels of compliance, while higher median income was positively associated with higher levels of compliance. When the researchers grouped incomes based on the 2018 federal tax classification brackets, they observed a significant association between compliance and median income (P less than .001), with a likelihood ratio of 20.4.

“Previous studies have shown that with increases in OSA disease severity, defined by higher [apnea-hypopnea index], comes increases in CPAP compliance, while other studies have alluded to the fact that lower socioeconomic status can affect CPAP compliance,” Dr. LoSavio and his associates wrote in their abstract. “A novel aspect of our study hoped to shed light on different otolaryngology-related diseases and how they might affect compliance. The patients with comorbid GERD, sinus headaches, and enlarged tonsils were less CPAP compliant in our study. These conditions are relatively easily treated and could therefore provide an avenue to increase CPAP compliance if addressed.” They acknowledged certain limitations of the study, including its single-center design and the self-reported nature of the patient questionnaire.

The researchers reported having no financial disclosures. The meeting was jointly sponsored by the Triological Society and the American College of Surgeons.

SOURCE: LoSavio P et al. Triological CSM 2019, Abstracts.

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