Adherence with positive airway pressure therapy for obstructive sleep apnea in developing versus developed countries: a big data study

J Clin Sleep Med. 2020 Nov 18. doi: 10.5664/jcsm.9008. Online ahead of print.


STUDY OBJECTIVES: Minimal focus has been placed on variations in health care delivery for obstructive sleep apnea (OSA). This study compared positive airway pressure (PAP) usage in developing countries (Brazil and Mexico) versus a developed country (United States, US), and investigated the impact of a patient engagement tool (myAir™; ResMed) on adherence.

METHODS: De-identified data from the AirView™ database (ResMed) for patients receiving PAP therapy with wirelessly connected Air10 (AirSense and AirCurve) devices in Brazil, Mexico and the US were analyzed. Adherence was defined using US Center for Medicare and Medicaid Services (CMS) criteria (usage ≥4 h/night on ≥70% of nights in the first 90 days).

RESULTS: The analysis included 4,181,490 patients (Brazil: 31,672; Mexico 16,934; US: 4,132,884). 90-day CMS adherence was slightly lower in Latin America versus the US (Brazil: 71.7%; Mexico: 66.4%; US: 74.0%). Significantly fewer patients were using the patient engagement tool in Brazil (8.1%) and Mexico (2.8%) versus the US (26%; both p<0.001). Patients registered to use an engagement tool had a higher rate of CMS adherence and were twice as likely to achieve CMS adherence. Average daily usage and days with usage >4 hours in the first week were the strongest predictors of CMS adherence. Across all countries, >80% of patients meeting CMS criteria at 3 months were still using PAP therapy at 1 year, with 1-year adherences rates of >75%.

CONCLUSIONS: Short- and long-term PAP adherence rates in Brazil and Mexico were similar to those achieved in the US. Patients who registered to use an engagement tool consistently had better adherence than those who did not.

PMID:33206044 | DOI:10.5664/jcsm.9008