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Adherence with positive airway pressure therapy for obstructive sleep apnea in developing vs. developed countries: a
Luciano F Drager1,2, Atul Malhotra3, Yang Yan4
1Hypertension Unit, Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil.
Summary
Positive airway pressure adherence for obstructive sleep apnea is similar in developing and developed countries. Patient engagement tools significantly improve adherence rates, highlighting their value in managing sleep apnea care globally.
Area of Science:
- Sleep Medicine
- Health Services Research
- Medical Technology
Background:
- Obstructive sleep apnea (OSA) management often relies on positive airway pressure (PAP) therapy.
- Variations in healthcare delivery for OSA are understudied, particularly comparing different economic settings.
- Patient engagement tools may influence therapy adherence, but their impact across diverse healthcare systems requires investigation.
Purpose of the Study:
- To compare positive airway pressure (PAP) usage and adherence in developing countries (Brazil, Mexico) versus a developed country (United States).
- To investigate the impact of a patient engagement tool on PAP adherence rates.
- To identify predictors of adherence to PAP therapy for obstructive sleep apnea.
Main Methods:
- Analysis of deidentified data from the AirView database (ResMed) for PAP therapy users with wirelessly connected devices.
- Inclusion of patients from Brazil, Mexico, and the United States.
- Adherence defined by US Center for Medicare and Medicaid Services (CMS) criteria: usage ≥ 4 hours/night on ≥ 70% of nights in the first 90 days.
Main Results:
- Over 4.1 million patients were analyzed; 90-day CMS adherence was comparable across regions (Brazil: 71.7%, Mexico: 66.4%, US: 74.0%).
- Significantly fewer patients used the engagement tool in Brazil (8.1%) and Mexico (2.8%) compared to the US (26%).
- Engagement tool users showed higher CMS adherence rates and were twice as likely to achieve adherence; early usage patterns strongly predicted adherence.
Conclusions:
- Short-term and long-term PAP adherence rates in Brazil and Mexico are comparable to those in the United States.
- Patients utilizing a patient engagement tool demonstrated consistently better adherence.
- Patient engagement tools are effective in improving PAP adherence across different healthcare settings.
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