Accessibility and adherence to positive airway pressure treatment in patients with obstructive sleep apnea: a multicenter study in Latin America
Information on access and adherence to positive airway pressure (PAP) treatment is lacking at the regional level in Latin America. This study characterized access and adherence to PAP in patients with moderate-severe obstructive sleep apnea (OSA) in Latin America.
Cross-sectional study, conducted at 9 sleep centers across Argentina, Brazil, Chile, Colombia, Mexico, and Peru. Adults diagnosed with moderate-severe OSA (apnea-hypopnea index [AHI] ≥ 15/h) in the previous 12–18 months were eligible. Anthropometrics, health coverage, and OSA severity data were collected. Data on access to therapy, barriers to access, adherence, and factors related to non-compliance were obtained via standardized telephone survey.
Eight hundred eighty patients (70% male, 54 ± 13 years, AHI 49 ± 28/h, body mass index 32 ± 7 kg/m2) were included. Four hundred ninety patients (56%) initiated PAP, 70 (14%) discontinued therapy during the first year (mainly due to intolerance), and 420 (48%) were still using PAP when surveyed. Health insurance was private in 36.9% of patients, via the social security system in 31.1%, and via the state in 13.3%, and 18.7% did not have any coverage; 49.5% of patients had to pay all equipment costs. Reasons for not starting PAP were unclear or absent indication (42%), coverage problems (36%), and lack of awareness of OSA burden (14%). Patients with better adherence were older (55.3 ± 13 vs 52 ± 13; p = 0.002) and had more severe OSA (AHI 51.8 ± 27 vs 45.6 ± 27; p = 0.001).
Less than half moderate-severe OSA patients started and continue to use PAP. Unclear or absent medical indication and financial limitations were the most relevant factors limiting access to therapy.
KeywordsObstructive sleep apnea Continuous positive airway pressure Compliance to treatment Latin America
The authors want to acknowledge Victoria Santiago-Ayala, Yoaly Arana Lechuga, Javier Velázquez Moctezuma, Carolina Silva, Andrea Esguerra, Ricardo Silvestre Bello Carrera, and Rocío López Acuña for their invaluable contribution to the development of this research project. The material has been reviewed by the Walter Reed Army Institute of Research. There is no objection to its presentation and/or publication. The opinions or assertions contained herein are the private views of the author, and are not to be construed as official, or as reflecting true views of the Department of the Army or the Department of Defense. The investigators have adhered to the policies for protection of human subjects as prescribed in AR 70–25. English language editing assistance was provided by Nicola Ryan, independent medical writer, funded by ResMed.
ResMed provided financial support to cover the costs of the surveyors, data entry, and English language editing support. ResMed did not participate in the design of the study, nor in the collection and analysis of the data. Lía Bittencourt received a grant from Associação Fundo de Incentivo a Pesquisa (AFIP) and Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Grant number: 309336/2017-1.
Compliance with ethical standards
Conflict of interest
Juan Facundo Nogueira has received financial support from ResMed, destinated to cover the cost of study procedures. Dalva Poyares has received financial support from ResMed, destinated to cover the cost of study procedures. Guido Simonelli declares that he has no conflict of interest. Sebastián Leiva declares that he has no conflict of interest. José Luis Carrillo-Alduenda has received financial support from ResMed, destinated to cover the cost of study procedures. María Angélica Bazurto has received financial support from ResMed, destinated to cover the cost of study procedures. Guadalupe Terán has received financial support from ResMed, destinated to cover the cost of study procedures. Matilde Valencia-Flores has received financial support from ResMed, destinated to cover the cost of study procedures. Leonardo Serra has received financial support from ResMed, destinated to cover the cost of study procedures. Jorge Rey de Castro has received financial support from ResMed, destinated to cover the cost of study procedures. Victoria Santiago-Ayala declares that she has no conflict of interest. Daniel Pérez-Chada has received financial support from ResMed, destinated to cover the cost of study procedures. María Eugenia Franchi declares that she has no conflict of interest. Ligia Lucchesi declares that she has no conflict of interest. Sergio Tufik declares that he has no conflict of interest. Lia Bittencourt has received financial support from ResMed, destinated to cover the cost of study procedures and received a grant from Associação Fundo de Incentivo a Pesquisa (AFIP) and Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Grant number: 309336/2017-1.
This study has been approved by the Ethics committee of the participating institutions (Approval Certificate: 2014-195). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
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