12 Mar Understanding the distribution and adherence of CPAP by age and sex.
Research shows that adherence to CPAP therapy ranges from 17% to 71%.
CPAP remains a highly effective treatment option for patients with OSA and is effective in improving health outcomes including sleep quality, daytime alertness. Improving overall health outcomes in this group of patients is dependent upon increasing the rates of treatment adherence to CPAP therapy.
A study of 789,260 patients, who were prescribed CPAP treatment, demonstrated that 72.6% of patients adhered to treatment. Significantly, there was a dramatic variance when comparing for age and sex. Over the trial period of 90 days young women, aged between 18 and 30 years old, showed an adherence rate of 51.3%, compared to 80.6% of men aged between 71 and 80 years old. This trend continued for the mean nightly usage and mean hours of usage each night.
The reasons for the disparity in adherence between these two groups is suggested to be fundamentally related to balancing one’s belief in their capacity to commit to treatment, one’s own expectations of treatment outcomes and the risks associated with being non-compliant.
It is suggested that concepts of OSA and CPAP treatment and lifestyle all play a role, some of which include:
- OSA is seen as a male disease, where women are often reluctant to admit they have the disorder and are therefore less reluctant to accept treatment options, including CPAP therapy.
- Woman may feel that they have a higher expectation on their physical appearance, and using CPAP for sleep compromises their feelings of attractiveness, and thus may be a barrier to complying to CPAP therapy.
- Claustrophobia is sited to be more common among women than men and is a challenge to complying with ongoing CPAP therapy.
- Reported symptoms of insomnia and fatigue, which are more commonly reported by women, may be less responsive to CPAP therapy. When no positive feedback gain is experienced from CPAP therapy, then it may be more quickly disregarded as a treatment option.
These differences in reported symptoms by women, may require physicians to include different outcome expectations than those experienced by men. Women tend to present with different phenotypic presentations of OSA compared to men. Women tend to have lower severity of OSA, expressed by AHI, but significantly a greater incidence of REM related OSA, with higher rates of hypopneas and higher incidence of sub criterion flow limitation respiratory events. These differences require differences in optimum CPAP settings and efficacy of treatment.
Patel SR, Bakker JP, Stitt CJ, Aloia MS, Nouraie SM. Age and Sex Disparities in Adherence to CPAP. Chest. 2021 Jan;159(1):382-389. doi: 10.1016/j.chest.2020.07.017. Epub 2020 Jul 17. PMID: 32687910; PMCID: PMC7803941.