Socioeconomic factors and adherence to CPAP – the population-based DISCOVERY study.

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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).How does socioeconomic factors influence CPAP adherence?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.In total, 20,521 patients were included: 70.7% males, age 57.8±12.2 years, BMI 32.0±6.1 kg/m2, 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).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.

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Authors: Andreas Palm, Ludger Grote, Jenny Theorell-Haglöw, Mirjam Ljunggren, Josefin Sundh, Bengt Midgren, Magnus Ekström