Juan Facundo Nogueira1, Dalva Poyares2, Guido Simonelli3, Sebastián Leiva4, José Luis Carrillo-Alduenda5, María Angélica Bazurto6, Guadalupe Terán7, Matilde Valencia-Flores8, Leonardo Serra9, Jorge Rey de Castro10, Victoria Santiago-Ayala8, Daniel Pérez-Chada11, María Eugenia Franchi11, Ligia Lucchesi2, Sergio Tufik2, Lia Bittencourt2. 1. Hospital de Clínicas, Universidad de Buenos Aires, Buenos Aires, Argentina. dr.facundo.nogueira@gmail.com. 2. Universidade Federal de São Paulo-SP, São Paulo, Brazil. 3. Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA. 4. Hospital de Clínicas, Universidad de Buenos Aires, Buenos Aires, Argentina. 5. Instituto Nacional de Enfermedades Respiratorias (INER), Ciudad de México, Mexico. 6. Fundación Neumológica Colombiana, Bogotá, Colombia. 7. Universidad Autónoma Metropolitana (UAM), Ciudad de México, Mexico. 8. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico. 9. Clínica Alemana, Universidad del Desarrollo, Santiago, Chile. 10. Clínica Anglo Americana, Univ. Peruana Cayetano Heredia, Lima, Peru. 11. Hospital Austral, Universidad Austral, Buenos Aires, Argentina.
Abstract
PURPOSE: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.
PURPOSE: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.
Entities:
Keywords:
Compliance to treatment; Continuous positive airway pressure; Latin America; Obstructive sleep apnea
Authors: Daniela V Pachito; Ângela M Bagattini; Luciano F Drager; Alan L Eckeli; Aline Rocha Journal: Sleep Breath Date: 2021-03-31 Impact factor: 2.816
Authors: Luciano F Drager; Atul Malhotra; Yang Yan; Jean-Louis Pépin; Jeff P Armitstead; Holger Woehrle; Carlos M Nunez; Peter A Cistulli; Adam V Benjafield Journal: J Clin Sleep Med Date: 2021-04-01 Impact factor: 4.062