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Socioeconomic Status and CPAP
Low-income patients with obstructive sleep apnea are less likely to start CPAP therapy
Press Release of the American Academy of Sleep Medicine
Westchester, Ill. — A study in the April 1 issue of the journal SLEEP demonstrates that low socioeconomic status independently predicts the poor acceptance of continuous positive airway pressure (CPAP) therapy for obstructive sleep apnea, and patients with higher incomes are more likely to begin treatment. The authors suggest that CPAP support programs should be better tailored to the needs of low-income patients to improve CPAP acceptance and adherence.
Results show that 60 percent of patients requiring CPAP (97 of 162) declined to purchase the device. The odds of CPAP purchase for patients in the highest third of income level were 5.76 times greater than the odds of those in the lowest third of income level. For each increase in income level category, the odds for CPAP acceptance increased by 140 percent.
According to principal investigator Ariel Tarasiuk, PhD, director of the Sleep-Wake Disorder Unit of Soroka University Medical Center at Ben-Gurion University of the Negev in Beer Sheva, Israel, a patient's income level is an important factor that may affect the decision either to initiate or decline CPAP treatment.
"The current study provides strong evidence that low-socioeconomic status is an additional important risk factor affecting CPAP acceptance and adherence," said Tarasiuk. "Physicians should consider that patients with low socioeconomic status have an additional risk factor for obstructive sleep apnea and are poor candidates for CPAP treatment adherence."
The study involved 162 consecutive adult patients who were newly diagnosed with obstructive sleep apnea by overnight polysomnography and who required treatment with CPAP. About two weeks after the sleep study CPAP titration was performed to determine the level of air pressure needed to eliminate breathing pauses during sleep. Patients then were encouraged to begin a two-week adaptation period to begin CPAP treatment. A CPAP support program provided patients with educational information, helpful instructions and encouragement. Four to six weeks after the adaptation period, the researchers confirmed patients' final decision to purchase CPAP or decline treatment.
Low socioeconomic status was defined as having an individual monthly income below the Israeli national average. Forty-three percent of patients who declined CPAP had a low socioeconomic status, while only 14 percent of patients who accepted CPAP had a low income. {1 of 2}
Thirty-eight percent of patients declining CPAP reported that the treatment causes side effects; 31 percent said they are interested in other treatments; 29 percent said they could not adapt to the treatment; and 29 percent said CPAP is too expensive. In Israel treatment requires an out-of-pocket payment of about 30 percent of the CPAP cost.
According to Tarasiuk, primary care physicians currently do not provide patients with sufficient information about obstructive sleep apnea and CPAP therapy. He suggests that patients with low socioeconomic status may be less compliant with CPAP because they are less knowledgeable about their disease and treatment options.
The authors report that physicians can play an important, proactive role in a patient's decision to comply with CPAP by promoting positive beliefs and expectations about CPAP before treatment is initiated. Support protocols for patients and spouses, provision of information regarding risks involved with sleep apnea, and continuous corrective feedback during treatment may improve CPAP adherence.
According to the American Academy of Sleep Medicine, most people with obstructive sleep apnea snore loudly and frequently, with periods of silence when airflow is reduced or blocked. They then make choking, snorting or gasping sounds when their airway reopens. About 80 percent to 90 percent of adults with sleep apnea remain undiagnosed.
CPAP is the most common treatment for obstructive sleep apnea. It provides a steady stream of air through a mask that is worn during sleep, keeping the airway open to restore normal oxygen levels.
Press Release of the American Academy of Sleep Medicine
Westchester, Ill. — A study in the April 1 issue of the journal SLEEP demonstrates that low socioeconomic status independently predicts the poor acceptance of continuous positive airway pressure (CPAP) therapy for obstructive sleep apnea, and patients with higher incomes are more likely to begin treatment. The authors suggest that CPAP support programs should be better tailored to the needs of low-income patients to improve CPAP acceptance and adherence.
Results show that 60 percent of patients requiring CPAP (97 of 162) declined to purchase the device. The odds of CPAP purchase for patients in the highest third of income level were 5.76 times greater than the odds of those in the lowest third of income level. For each increase in income level category, the odds for CPAP acceptance increased by 140 percent.
According to principal investigator Ariel Tarasiuk, PhD, director of the Sleep-Wake Disorder Unit of Soroka University Medical Center at Ben-Gurion University of the Negev in Beer Sheva, Israel, a patient's income level is an important factor that may affect the decision either to initiate or decline CPAP treatment.
"The current study provides strong evidence that low-socioeconomic status is an additional important risk factor affecting CPAP acceptance and adherence," said Tarasiuk. "Physicians should consider that patients with low socioeconomic status have an additional risk factor for obstructive sleep apnea and are poor candidates for CPAP treatment adherence."
The study involved 162 consecutive adult patients who were newly diagnosed with obstructive sleep apnea by overnight polysomnography and who required treatment with CPAP. About two weeks after the sleep study CPAP titration was performed to determine the level of air pressure needed to eliminate breathing pauses during sleep. Patients then were encouraged to begin a two-week adaptation period to begin CPAP treatment. A CPAP support program provided patients with educational information, helpful instructions and encouragement. Four to six weeks after the adaptation period, the researchers confirmed patients' final decision to purchase CPAP or decline treatment.
Low socioeconomic status was defined as having an individual monthly income below the Israeli national average. Forty-three percent of patients who declined CPAP had a low socioeconomic status, while only 14 percent of patients who accepted CPAP had a low income. {1 of 2}
Thirty-eight percent of patients declining CPAP reported that the treatment causes side effects; 31 percent said they are interested in other treatments; 29 percent said they could not adapt to the treatment; and 29 percent said CPAP is too expensive. In Israel treatment requires an out-of-pocket payment of about 30 percent of the CPAP cost.
According to Tarasiuk, primary care physicians currently do not provide patients with sufficient information about obstructive sleep apnea and CPAP therapy. He suggests that patients with low socioeconomic status may be less compliant with CPAP because they are less knowledgeable about their disease and treatment options.
The authors report that physicians can play an important, proactive role in a patient's decision to comply with CPAP by promoting positive beliefs and expectations about CPAP before treatment is initiated. Support protocols for patients and spouses, provision of information regarding risks involved with sleep apnea, and continuous corrective feedback during treatment may improve CPAP adherence.
According to the American Academy of Sleep Medicine, most people with obstructive sleep apnea snore loudly and frequently, with periods of silence when airflow is reduced or blocked. They then make choking, snorting or gasping sounds when their airway reopens. About 80 percent to 90 percent of adults with sleep apnea remain undiagnosed.
CPAP is the most common treatment for obstructive sleep apnea. It provides a steady stream of air through a mask that is worn during sleep, keeping the airway open to restore normal oxygen levels.
Views: 3
Replies to This Discussion
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Permalink Reply by Judy on
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Given the drastic inflated markup for durable medical equipment including CPAP and accessories this comes as a surprise to anyone???? Duh! And double duh!!!!
Add to that the very poor support, advice and encouragemnt new apnea patients receive, if they even receive any at all .... and poor compliance comes as a surprise to anyone?? Another double duh!
Picture the poor apnean who is told, yup, you have sleep apnea, go home, your equipment will be provided shortly, NOT by a doctor but by some office staff. Then one day a box arrives by UPS or USPS, etc. w/a bunch of equipment and some written instructions.
And anyone expects this apnean to be compliant???? The above DOES happen! Its not the norm but it does happen more often than one would expect. Add to this those who NEVER see or talk to a sleep doctor. Those who encounter a local DME supplier who hands them a mask and doesn't allow for mask exchanges, who allows no choice of device but foists off the cheapest device they can get away with providing, who doesn't provide any support or advice, or less than truthful advice .... etc, etc. and anyone wonders why CPAP compliance is so low??? Duh!!!!
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Permalink Reply by sleepycarol on
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Many in the low socio-economic status group are not well educated. They maybe having trouble with meeting their everyday needs such as food, clothing, shelter, and ecking by with little hope of ever having more. Many do not have the resources available to even know about, let alone try to understand, what sleep apnea is. Their reading skills may not be to the level that reading literature or even, a newspaper, is very difficult. Many do not have access to the internet, either because of affordability or lack of communication skills (it takes a certain amount of communication skills to do searches on the internet and then be able to distinguish fact from fantasy -- ie snake oil remedies).
Think about it, your choices are buying a machine (with very little understanding of why) or paying for very basic needs for a significant period of time. Paying for basic needs is going to win hands down.
I am not trying saying that those in the lower economic bracket should be forgotten about. On the contrary -- affordable means of diagnosing and treatment options should be available, along with the education to understand the importance of compliance.
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Permalink Reply by Mike on
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SleepyCarol raises a terrific point. but it does appear as the time might be near when there's affordable treatment available for people with limited means. i think the disposable Provent nasal devices that they're coming out with were designed with this purpose in mind. since it's such a new treatment, i don't have many data points on how well these work/whether people like them. but there's some solid science behind them. that much i know.
sleepycarol said:Many in the low socio-economic status group are not well educated. They maybe having trouble with meeting their everyday needs such as food, clothing, shelter, and ecking by with little hope of ever having more. Many do not have the resources available to even know about, let alone try to understand, what sleep apnea is. Their reading skills may not be to the level that reading literature or even, a newspaper, is very difficult. Many do not have access to the internet, either because of affordability or lack of communication skills (it takes a certain amount of communication skills to do searches on the internet and then be able to distinguish fact from fantasy -- ie snake oil remedies).
Think about it, your choices are buying a machine (with very little understanding of why) or paying for very basic needs for a significant period of time. Paying for basic needs is going to win hands down.
I am not trying saying that those in the lower economic bracket should be forgotten about. On the contrary -- affordable means of diagnosing and treatment options should be available, along with the education to understand the importance of compliance.
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Permalink Reply by amott1973 on
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My mom has some experience with the way medicaid handles OSA and cpap. She'd already had a machine and mask from years before, but needed a new one. Once she finally was eligible for medicaid, she went to get help with her sleep apnea. She was given a new mask (no choice in the mask) and sent out the door. No instruction on fitting the mask or offers to swap it out or anything. The mask she got was the Comfortselect Nasal Mask. Not a stellar one, and one that definitlely requires some instruction and help with fitting in my opinion.
She came for a visit not too long after getting it, and I was able to help her with it, but still! Not a lot of folks would be able to have someone in the family who could help them. I think my experience with the company who handled my cpap supplies defintely helped me to be more committed to my therapy. They were so helpful and supportive, always would let me swap out masks and send me away with lots of extra supplies like a new hose and filters, stuff that I wouldn't have thought to ask for, and that my mom certainly doesn't get! In fact I have saved my new hoses to give to her sometimes.
I think the care and support we tend to get as insured people is probably a huge contributor to the difference in compliance.
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Permalink Reply by RockRpsgt on
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I agree with you whole heartedly. I will say however that medicaer has come along way in the last couple of years as far as CPAP is concerned. The medicaid alternative scoring rules are making it easier for pts to get CPAP. Also DMEs are being forced to give these pts better choices.
amott1973 said:My mom has some experience with the way medicaid handles OSA and cpap. She'd already had a machine and mask from years before, but needed a new one. Once she finally was eligible for medicaid, she went to get help with her sleep apnea. She was given a new mask (no choice in the mask) and sent out the door. No instruction on fitting the mask or offers to swap it out or anything. The mask she got was the Comfortselect Nasal Mask. Not a stellar one, and one that definitlely requires some instruction and help with fitting in my opinion.
She came for a visit not too long after getting it, and I was able to help her with it, but still! Not a lot of folks would be able to have someone in the family who could help them. I think my experience with the company who handled my cpap supplies defintely helped me to be more committed to my therapy. They were so helpful and supportive, always would let me swap out masks and send me away with lots of extra supplies like a new hose and filters, stuff that I wouldn't have thought to ask for, and that my mom certainly doesn't get! In fact I have saved my new hoses to give to her sometimes.
I think the care and support we tend to get as insured people is probably a huge contributor to the difference in compliance.
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