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. 2021 Oct;160(4):1481-1491.
doi: 10.1016/j.chest.2021.04.064. Epub 2021 May 8.

Socioeconomic Factors and Adherence to CPAP: The Population-Based Course of Disease in Patients Reported to the Swedish CPAP Oxygen and Ventilator Registry Study

Andreas Palm  1 , Ludger Grote  2 , Jenny Theorell-Haglöw  3 , Mirjam Ljunggren  3 , Josefin Sundh  4 , Bengt Midgren  5 , Magnus Ekström  5
Affiliations

Socioeconomic Factors and Adherence to CPAP: The Population-Based Course of Disease in Patients Reported to the Swedish CPAP Oxygen and Ventilator Registry Study

Andreas Palm et al. Chest. 2021 Oct.

Abstract

Background: Early identification of poor adherence to CPAP treatment is of major clinical importance to optimize treatment outcomes in patients with OSA.

Research question: How do socioeconomic factors influence CPAP adherence?

Study design and methods: Nationwide, population-based cohort study of patients with OSA receiving CPAP treatment reported to the Swedish quality registry Swedevox between 2010 and 2018 was cross-linked with individual socioeconomic data from Statistics Sweden. Socioeconomic factors associated with CPAP adherence were identified using a multivariate linear regression model, adjusted for age and sex.

Results: In total, 20,521 patients were included: 70.7% men; mean age ± SD, 57.8 ± 12.2 years; BMI, 32.0 ± 6.1 kg/m2; apnea-hypopnea index, 36.9 ± 22.1; Epworth Sleepiness Scale, 10.4 ± 5.0; and median nocturnal CPAP use, 355 min (interquartile range, 240-420 min). Adherence after 1.3 ± 0.8 years of CPAP use was significantly (all P < .001) associated with civil status (married vs unmarried: +20.5 min/night), education level (high, ≥ 13 years vs low, ≤ 9 years: +13.2 min/night), total household income (highest/third/second vs lowest quartile: +15.9 min/night, +10.4 min/night, and +6.1 min/night, respectively), and country of birth (born in Sweden with one native parent/born in Sweden with two native parents vs being born abroad: +29.0 min/night and +29.3 min/night, respectively).

Interpretation: Civil status, educational level, household income, and foreign background predict CPAP adherence in a clinically significant manner and should be considered when treating OSA with CPAP.

Keywords: CPAP; OSA; adherence; socioeconomic factors.

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Figures

Figure 1
Figure 1
Study flowchart.
Figure 2
Figure 2
Direct acyclic graph identifying main confounders among the covariates. Dependent variable is nocturnal CPAP use time. AHI = apnea-hypopnea index; ESS = Epworth Sleepiness Scale; SES = socioeconomic status.
Figure 3
Figure 3
Forest plot showing the contribution of independent variables on total nocturnal CPAP use (min/night). AHI = apnea-hypopnea index; ESS = Epworth Sleepiness Scale.
See this image and copyright information in PMC

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