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Low-Income Sleep Apnea Patients Don’t Pursue Recommended Treatment

Low-Income Sleep Apnea Patients Don’t Pursue Recommended Treatment

April 2, 2009

Medical Research, Press Releases

BEER-SHEVA, ISRAEL — April 1, 2009 — A new study by Ben-Gurion University of the Negev (BGU) researchers reveals that a patient’s income level is an important factor that may affect the decision either to initiate or decline one of the most common therapies in treating obstructive sleep apnea.
A study in the April 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 while 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.

CPAP, the most common treatment for obstructive sleep apnea, provides a steady stream of air through a mask that is worn during sleep, keeping the airway open to restore normal oxygen levels.  

According to the American Academy of Sleep Medicine (AASM), 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. 

Roughly 80 to 90 percent of adults with sleep apnea remain undiagnosed.

According to the study in Israel, 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.   

“The current study provides strong evidence that low socioeconomic status is an additional important risk factor affecting CPAP acceptance and adherence,” said principal investigator Prof. Ariel Tarasiuk, department of Physiology and Neurobiology, Faculty of Health and Sciences at BGU and director of the Sleep-Wake Disorder Unit of Soroka University Medical Center in Beer-Sheva.  

“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.

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 Prof. 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. 

About American Associates, Ben-Gurion University of the Negev

American Associates, Ben-Gurion University of the Negev (AABGU) plays a vital role in sustaining David Ben-Gurion’s vision: creating a world-class institution of education and research in the Israeli desert, nurturing the Negev community and sharing the University’s expertise locally and around the globe. Activities include showcasing BGU’s academic excellence and cutting-edge research through educational programs, events and informative communications. AABGU’s main purpose is to support Ben-Gurion’s vision and the university that bears his name by creating a community of Americans committed to improving the world tomorrow from the heart of the Israeli desert today.

Media Contact:
Andrew Lavin
A. Lavin Communications