Indian Journal of Sleep Medicine

Register      Login

VOLUME 7 , ISSUE 4 ( October-December, 2012 ) > List of Articles

ORIGINAL ARTICLE

CPAP therapy in OSA – A gap analysis between recommendation and usage

Ramakrishnan Nagarajan, Arvind K Sundaram, Mary I Charles

Keywords : Continuous positive airway pressure therapy, obstructive sleep apnea, barriers, cost, acceptance, adherence

Citation Information : Nagarajan R, Sundaram AK, Charles MI. CPAP therapy in OSA – A gap analysis between recommendation and usage. Indian Sleep Med 2012; 7 (4):150-156.

DOI: 10.5958/j.0974-0155.7.4.022

License: CC BY-SA 4.0

Published Online: 01-10-2012

Copyright Statement:  Copyright © 2012; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Objectives: To examine various factors, primarily socioeconomic, psychological, and physiological, which influence the decision of patients diagnosed with obstructive sleep apnea (OSA) to purchase a continuous positive airway pressure (CPAP) device. Methods: The first phase involved 343 patients, undergoing polysomnography (PSG), with informed consent from amongst 1,098 subjects, who presented to a comprehensive Sleep Center in Chennai, India. Among those diagnosed with OSA, a certain number were recommended CPAP therapy, based on the test results and clinical appropriateness. The second phase involved follow-up of these patients prescribed with CPAP. Patients were interviewed on whether they purchased CPAP devices or not, and the most relevant reasons for their decision. Results: All 343 subjects who underwent the PSG were diagnosed with varying degrees of OSA. Among them, 291 were recommended to use a CPAP device. 41.9% of patients who were prescribed CPAP purchased the device. Out of these, 84.42% responded that it improved their quality of life and relieved OSA symptoms. Those who did not purchase CPAP, stated reasons such as high device cost (36.69%), deferment due to lack of awareness and education (17.75%), lack of awareness on the cost benefits of the device (11.24%), and discomfort during usage (8.88%). Conclusion: Patients who used CPAP device report improved quality of life. However, amongst those who did not opt for CPAP therapy, socioeconomic factors appear to be the foremost deterrent followed by other factors such as lack of understanding of the importance of therapy and perceived discomfort with the equipment & interface.


PDF Share
  1. Kapsimalis F, Kryger MH. Gender and obstructive sleep apnea syndrome, part 1: Clinical features. Sleep 2002;25:412-419.
  2. Cao MT, Guilleminault C, Kushida CA. Chapter 105 – Clinical Features and Evaluation of Obstructive Sleep Apnea and Upper Airway Resistance Syndrome. Principles and Practice of Sleep Medicine. 5th Edition ed: Elsevier; 2011.
  3. Martin SE, Engleman HM, Deary IJ, Douglas NJ. The effect of sleep fragmentation on daytime function. Am J Respir Crit Care Med 1996;153:1328-1332.
  4. Shahar E, Whitney CW, Redline S, et al. Sleep-disordered breathing and cardiovascular disease. Am J Respir Crit Care Med 2001;163:19-25.
  5. Peppard PE, Young T, Palta M, Skatrud J. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med 2000;342:1378-1384.
  6. Sasanabe R, Banno K, Otake K, et al. Metabolic syndrome in Japanese patients with obstructive sleep apnea syndrome. Hypertens Res 2006;29:315-322.
  7. Chaudhary BA, Speir WA, Jr. Sleep apnea syndromes. South Med J 1982;75:39-45.
  8. Young T, Hutton R, Finn L, Badr S, Palta M. The gender bias in sleep apnea diagnosis: are women missed because they have different symptoms? Arch Intern Med 1996;156: 2445-2451.
  9. Stewart DE, Cheung AM, Layne D, Evis M. Are we there yet? The representation of women as subjects in clinical research. Ann R Coll Physicians Surg Can 2000;33:229- 231.
  10. Robert J 0 Davies, Stradling JR. The epidemiology of sleep apnoea. Thorax 1996;51:565-570.
  11. Lindberg E, Gislason T. Epidemiology of sleep-related obstructive breathing. Sleep Med Rev 2000;4:411-433.
  12. Sharma SK, Kumpawat S, Banga A, Goel A. Prevalence and risk factors of obstructive sleep apnea syndrome in a population of Delhi, India. Chest 2006;130:149-156.
  13. Reddy EV, Kadhiravan T, Mishra HK, et al. Prevalence and risk factors of obstructive sleep apnea among middle-aged urban Indians: A community-based study. Sleep Med 2009;10:913-918.
  14. Vijayan VK, Patial K. Prevalence of obstructive sleep apnea syndrome (OSAS) in Delhi, India. Chest 2006;130:92S-c-.
  15. Cordero-Guevara J, Teran-Santos J, Luz Alonso-Alvarez M, Castrodeza-Sanz J, Ordax-Carbajo E, Masa-Jimenez F. Effectiveness of nasal continuous positive airway pressure (CPAP) therapy on cardiovascular outcomes in obstructive sleep apnea-hypopnea syndrome (OSAHS). Curr Respir Med Rev 2011;7:121-129.
  16. Craig SE, Kohler M, Nicoll D, et al. S13 The primary results of the MOSAIC trial: does CPAP for minimally symptomatic OSA reduce daytime sleepiness or calculated vascular risk? Thorax 2010;65:A9.
  17. Avlonitou E, Kapsimalis F, Varouchakis G, Vardavas C, Behrakis P. Adherence to CPAP therapy improves quality of life and reduces symptoms among obstructive sleep apnea syndrome patients. Sleep Breath 2012;16:563-569.
  18. Simon-Tuval T, Reuveni H, Greenberg-Dotan S, Oksenberg A, Tal A, Tarasiuk A. Low socioeconomic status is a risk factor for CPAP acceptance among adult OSAS patients requiring treatment. Sleep 2009;32:545-52.
  19. Shapiro GK, Shapiro CM. Factors that influence CPAP adherence: an overview. Sleep Breath 2010;14:323-335.
  20. Engleman HM, Martin SE, Douglas NJ, Deary IJ. Effect of continuous positive airway pressure treatment on daytime function in sleep apnoea/hypopnoea syndrome. The Lancet 1994;343:572-575.
  21. Gay P, Weaver T, Loube D, Iber C. Evaluation of positive airway pressure treatment for sleep related breathing disorders in adults. Sleep 2006;29:381-401.
  22. Montserrat JM, Ferrer M, Hernandez L, et al. Effectiveness of CPAP treatment in daytime function in sleep apnea syndrome. Am J Respir Crit Care Med 2001;164:608-613.
  23. Tarasiuk A, Reznor G, Greenberg-Dotan S, Reuveni H. Financial incentive increases CPAP acceptance in patients from low socioeconomic background. PLoS One 2012;7:e33178.
  24. Schneider ME. Medicare Expands Coverage of CPAP Devices. Family Practice News 1 May 2008. Available from http://fpn.imng.com/fileadmin/content_pdf/fpn/ archive_pdf/vol38iss9/70630_main.pdf
  25. Department of Health & Human Services (DHHS). Medicare Coverage Issues Manual. In: (CMS) CfMMS, ed. Transmittal 150: Department of Health & Human Services (DHHS); 2001.
  26. Suri JC, Sen MK, Ojha UC. Acceptance and compliance issues of nasal cpap amongst Indian patients of obstructive sleep apnea. Indian J Sleep Med 2006;1:197-203.
  27. Hoy CJ, Vennelle M, Kingshott RN, Engleman HM, Douglas NJ. Can intensive support improve continuous positive airway pressure use in patients with the sleep apnea/hypopnea syndrome? Am J Respir Crit Care Med 1999;159:1096- 1100.
  28. Jean Wiese H, Boethel C, Phillips B, Wilson JF, Peters J, Viggiano T. CPAP compliance: video education may help! Sleep Med 2005;6:171-174.
  29. Comette A, Mougel D. Ventilatory assistance via the nasal route: masks and fittings. Eur Respir Rev 1993;3:250-253.
  30. Waldhorn RE, Herrick TW, Nguyen MC, O'Donnell AE, Sodero J, Potolicchio SJ. Long-term compliance with nasal continuous positive airway pressure therapy of obstructive sleep apnea. Chest 1990;97:33-38.
  31. Jones DJ, Braid GM, Wedzicha JA. Nasal masks for domiciliary positive pressure ventilation: patient usage and complications. Thorax 1994;49(8):811-812.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.