Age and Sex Disparities in Adherence to CPAP

Patel, Sanjay R.; Bakker, Jessie P.; Stitt, Christy J.; Aloia, Mark S.; Nouraie, Mehdi

doi:10.1016/j.chest.2020.07.017

Cited by 71 publications

(48 citation statements)

References 21 publications

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“…In line with this, we did not find a significant difference in adherence among the various age groups. Our results conflict with a recent analysis of a large cohort from the United States which found age a significant predictor for CPAP adherence with patients aged 60–80 years being the most adherent (70–80% adherence rates) [ 35 ]. However, differences in reimbursement of CPAP between different countries needs to be considered when comparing the data.…”

Section: Discussioncontrasting

confidence: 99%

A Fully Remote Diagnostic and Treatment Pathway in Patients with Obstructive Sleep Apnoea during the COVID-19 Pandemic: A Single Centre Experience

Bikov

Khalil

Gibbons

et al. 2021

JCM

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The COVID-19 pandemic led to significant delays in the diagnostic and management pathway of patients with obstructive sleep apnoea (OSA). During the first wave of COVID-19, our department adopted a fully remote diagnostic (home cardiorespiratory polygraphy) and treatment (autoset continuous positive airway pressure, CPAP) approach. As a novel mode of service delivery, our aim was to evaluate our pathway and analyse factors associated with adherence to CPAP. We analysed the first 300 patients (51 ± 13 years, 48% men) who were set up on remote CPAP between 20 May 2020 and 11 September 2020. The associations between CPAP usage at 90 days and age, gender, body mass index, disease severity, Epworth Sleepiness Scale and comorbidities were investigated with linear and logistic regression analyses. A total of 124 patients (41.3%) were fully-adherent to CPAP therapy, defined as CPAP usage ≥ 4 h on ≥ 70% of the days. Only driving status was associated with adherence to CPAP. Patients who were adherent at 28 days were more likely to stay adherent at 90 days (3.77 odd ratio /3.10–4.45/ 95% confidence interval). We have shown that a fully remote diagnostic and treatment pathway for patients with OSA can be successfully delivered, and our preliminary outcomes of adherence to CPAP are comparable with published data.

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Section: Discussioncontrasting

confidence: 99%

A Fully Remote Diagnostic and Treatment Pathway in Patients with Obstructive Sleep Apnoea during the COVID-19 Pandemic: A Single Centre Experience

Bikov

Khalil

Gibbons

et al. 2021

JCM

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“…In our study, PAP adherence was generally higher in males than females and increases with increasing age. Females tend to have lower severity of OSA assessed by the AHI and female-speci c symptoms [15], which may explain lower PAP adherence rates than males. Older age being a predictor of better PAP adherence, may be due to less social stigma surrounding PAP therapy because of increased incidence of OSA at higher ages [16] and increased incidence of both symptoms and comorbidities [17].…”

Section: Discussionmentioning

confidence: 99%

Demographics, Sleep Apnea and Positive Airway Pressure (PAP) Treatment-Related Characteristics Associated with PAP Adherence: A Large Retrospective Community-Based Longitudinal Observational Study

Villa

Dales

Kendzerska

2021

Preprint

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Despite many years of research, multiple factors have inconsistently shown to be associated with positive airway pressure (PAP) adherence. We conducted a retrospective observational study to evaluate the association between selected demographics, obstructive sleep apnea (OSA) - and PAP treatment-related factors, generally available, and objective PAP therapy adherence.We considered all consented individuals with OSA who purchased a PAP device from a registered vendor (Ottawa, Ontario) between 2011 and 2017 who had usage data available. PAP adherence was measured objectively as PAP use for at least 4 hours on at least 70% of days on treatment. In our cohort, 7,147/11,634 (61.5%) of participants were deemed adherent to PAP. The median percentage of days PAP therapy was used was 82% (IQR: 48-97%), and the median number of days PAP therapy was used for greater than 4 hours was 95 (IQR: 28-372). In multivariable logistic regression considering all variables available, the effect of body mass index, age, and minimum SaO2 at baseline sleep study were significantly associated with PAP adherence.

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“… 51 54 Adherence is generally higher for aPAP devices, as used in this study, when compared with CPAP devices. 51 Two recent large national database studies reported conflicting results regarding gender effects on PAP adherence—either lower in men 51 or lower in women, 54 although it is not known whether any of these women were pregnant in those studies. It is possible that pregnant women concerned about potentially optimising fetal and maternal outcomes would be more adherent to PAP.…”

Section: Methodsmentioning

confidence: 99%

Sleep Apnea and Fetal Growth Restriction (SAFER) study: protocol for a pragmatic randomised clinical trial of positive airway pressure as an antenatal therapy for fetal growth restriction in maternal obstructive sleep apnoea

et al. 2021

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IntroductionFetal growth restriction (FGR) is a major contributor to fetal and neonatal morbidity and mortality with intrauterine, neonatal and lifelong complications. This study explores maternal obstructive sleep apnoea (OSA) as a potentially modifiable risk factor for FGR. We hypothesise that, in pregnancies complicated by FGR, treating mothers who have OSA using positive airway pressure (PAP) will improve birth weight and neonatal outcomes.Methods and analysisThe Sleep Apnea and Fetal Growth Restriction study is a prospective, block-randomised, single-blinded, multicentre, pragmatic controlled trial. We enrol pregnant women aged 18–50, between 22 and 31 weeks of gestation, with established FGR based on second trimester ultrasound, who do not have other prespecified known causes of FGR (such as congenital anomalies or intrauterine infection). In stage 1, participants are screened by questionnaire for OSA risk. If OSA risk is identified, participants proceed to stage 2, where they undergo home sleep apnoea testing. Participants are determined to have OSA if they have an apnoea-hypopnoea index (AHI) ≥5 (if the oxygen desaturation index (ODI) is also ≥5) or if they have an AHI ≥10 (even if the ODI is <5). These participants proceed to stage 3, where they are randomised to nightly treatment with PAP or no PAP (standard care control), which is maintained until delivery. The primary outcome is unadjusted birth weight; secondary outcomes include fetal growth velocity on ultrasound, enrolment-to-delivery interval, gestational age at delivery, birth weight corrected for gestational age, stillbirth, Apgar score, rate of admission to higher levels of care (neonatal intensive care unit or special care nursery) and length of neonatal stay. These outcomes are compared between PAP and control using intention-to-treat analysis.Ethics and disseminationThis study has been approved by the Institutional Review Boards at Washington University in St Louis, Missouri; Hadassah Hebrew University Medical Center, Jerusalem; and the University of Rochester, New York. Recruitment began in Washington University in November 2019 but stopped from March to November 2020 due to COVID-19. Recruitment began in Hadassah Hebrew University in March 2021, and in the University of Rochester in May 2021. Dissemination plans include presentations at scientific conferences and scientific publications.Trial registration numberNCT04084990.

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Age and Sex Disparities in Adherence to CPAP

Cited by 71 publications

References 21 publications

A Fully Remote Diagnostic and Treatment Pathway in Patients with Obstructive Sleep Apnoea during the COVID-19 Pandemic: A Single Centre Experience

A Fully Remote Diagnostic and Treatment Pathway in Patients with Obstructive Sleep Apnoea during the COVID-19 Pandemic: A Single Centre Experience

Demographics, Sleep Apnea and Positive Airway Pressure (PAP) Treatment-Related Characteristics Associated with PAP Adherence: A Large Retrospective Community-Based Longitudinal Observational Study

Sleep Apnea and Fetal Growth Restriction (SAFER) study: protocol for a pragmatic randomised clinical trial of positive airway pressure as an antenatal therapy for fetal growth restriction in maternal obstructive sleep apnoea

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