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

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. CHEST 2021; 160(4):1481-1491

Automated summary

This study found that marital status, education level, household income, and country of birth significantly influence CPAP adherence. These factors predict adherence to CPAP treatment in a clinically significant manner and should be taken into consideration when treating OSA.