To Örebro University

BACKGROUND: Early identification of poor adherence to continuous positive airway pressure (CPAP) treatment is of major clinical importance to optimize treatment outcomes in patients with obstructive sleep apnea (OSA).

RESEARCH QUESTION: How does socioeconomic factors influence CPAP adherence?

STUDY DESIGN AND METHODS: Nationwide, population-based cohort study on patients with OSA on CPAP 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 multivariable linear regression model, adjusted for age and gender.

RESULTS: , AHI 36.9±22.1, ESS 10.4±5.0, median nocturnal CPAP usage 355 interquartile range (IQR) 240-420 minutes. Adherence after 1.3±0.8 year of CPAP use was significantly (all p<0.001) associated with civil status (married vs. unmarried: +20.5 minutes/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 and +10.4 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 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.