Improved Adherence to Positive Airway Pressure Treatment after Covering National Health Insurance in Patient with Obstructive Sleep Apnea: A Tertiary Sleep Center Review
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Objectives: Obstructive sleep apnea (OSA) is a common clinical disease which has been associated with cardiovascular disease and sudden death. Positive airway pressure (PAP) is the most effective treatment for OSA; however, most patients experience difficulties in tolerating machines, masks, or economic burdens. In Korea, National Health Insurance (NHI) application for PAP started in July 2018. Therefore, this study aimed to evaluate the PAP adherence and factors contributing to good adherence after NHI coverage in Korea. Methods: A retrospective study was performed to examine 89 patients with OSA who were treated with PAP in 2019. All medical records were analyzed to obtain demographic and clinical data, including personal history, polysomnographic data, and PAP results. Results: A total of 66 participants were included, of which 56 (84.8%) were maintained on PAP therapy after 3 months, and 32 of 42 (76.1%) were maintained on PAP therapy after 6 months; prolonged rapid eye movement (REM) sleep latency, increased non- REM (NREM) apnea-hypopnea index (AHI), and supine AHI significantly contributed to good PAP adherence for 3 months. At 6 months, prolonged REM sleep latency, increased NREM AHI, supine AHI, and increased arousal index significantly contributed to good PAP adherence. However, comorbid hypertension contributed to poor PAP compliance. Conclusions: PAP adherence in patients with OSA was 84.8% after 3 months, and 76.1% after 6 months after NHI coverage in a regional tertiary sleep center in Korea. Prolonged REM sleep latency and increased supine AHI and NREM AHI significantly contributed to good adherence, whereas comorbid hypertension was a factor for poor PAP compliance.
Abstract
Objectives: Obstructive sleep apnea (OSA) is a common clinical disease which has been associated with cardiovascular disease and sudden death. Positive airway pressure (PAP) is the most effective treatment for OSA; however, most patients experience difficulties in tolerating machines, masks, or economic burdens. In Korea, National Health Insurance (NHI) application for PAP started in July 2018. Therefore, this study aimed to evaluate the PAP adherence and factors contributing to good adherence after NHI coverage in Korea. Methods: A retrospective study was performed to examine 89 patients with OSA who were treated with PAP in 2019. All medical records were analyzed to obtain demographic and clinical data, including personal history, polysomnographic data, and PAP results. Results: A total of 66 participants were included, of which 56 (84.8%) were maintained on PAP therapy after 3 months, and 32 of 42 (76.1%) were maintained on PAP therapy after 6 months; prolonged rapid eye movement (REM) sleep latency, increased non- REM (NREM) apnea-hypopnea index (AHI), and supine AHI significantly contributed to good PAP adherence for 3 months. At 6 months, prolonged REM sleep latency, increased NREM AHI, supine AHI, and increased arousal index significantly contributed to good PAP adherence. However, comorbid hypertension contributed to poor PAP compliance. Conclusions: PAP adherence in patients with OSA was 84.8% after 3 months, and 76.1% after 6 months after NHI coverage in a regional tertiary sleep center in Korea. Prolonged REM sleep latency and increased supine AHI and NREM AHI significantly contributed to good adherence, whereas comorbid hypertension was a factor for poor PAP compliance.
참고문헌 (21)
- Redline S, "Epidemiology and natural history of obstructive sleep apnea", Ear Nose Throat J, 72, pp.20~26 (1993)
- F. Javier Nieto, "Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. Sleep Heart Health Study", JAMA, 283(14), pp.1829~1836 (2000), American Medical Association (AMA)[DOI]
- J. Hung, "Association of sleep apnoea with myocardial infarction in men", The Lancet, 336(8710), pp.261~264 (1990), Elsevier BV[DOI]
- Shahar E, "leep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study", Am J Respir Crit Care Med, 163, pp.19~25 (2001)[DOI]
- Young T, "Sleep Disordered Breathing and Mortality: Eighteen-Year Follow-up of the Wisconsin Sleep Cohort", Sleep, 31, pp.1071~1078 (2008), Oxford University Press (OUP)[DOI]
- Susheel P. Patil, "Treatment of Adult Obstructive Sleep Apnea With Positive Airway Pressure: An American Academy of Sleep Medicine Systematic Review, Meta-Analysis, and GRADE Assessment", Journal of Clinical Sleep Medicine, 15(02), pp.301~334 (2019), American Academy of Sleep Medicine (AASM)[DOI]
- Ozkan Yetkin, "CPAP compliance in patients with obstructive sleep apnea syndrome", Sleep and Breathing, 12(4), pp.365~367 (2008), Springer Science and Business Media LLC[DOI]
- Seong SC, "Data resource profile: the nation-al health information database of the National Health Insurance Ser-vice in South Korea", Int J Epidemiol, 46, pp.799~800 (2017)[DOI]
- Richard B. Berry, "Rules for scoring respiratory events in sleep: update of the 2007 AASM manual for the scoring of sleep and associated events. Deliberations of the sleep apnea defini-tions task force of the American Academy of Sleep Medicine", Journal of Clinical Sleep Medicine, 08(05), pp.597~619 (2012), American Academy of Sleep Medicine (AASM)[DOI]
- 김명진, "폐쇄성 수면 무호흡증후군 환자에서 자동형 양압 호흡기치료의 순응도 예측인자 분석", Journal of Rhinology, 22(2), pp.89~95 (2015), 대한비과학회
- Han EK, "The compliance and effect of CPAP in obstructive sleep apnea syndrome", Sleep Med Psychophysiol, 13, pp.52~58 (2006)
- Choi JB, "Compliance of nasal continuous positive airway pressure in patients with obstructive sleep apnea syndrome", Sleep Med Psychophysiol, 13, pp.27~32 (2006)
- Christopher J. Lettieri, "Group Education on CPAP–A Response", Journal of Clinical Sleep Medicine, 09(09), pp.975~976 (2013), American Academy of Sleep Medicine (AASM)[DOI]
- Melanie K. Means, "Ethnic Differences in Continuous Positive Airway Pressure (CPAP) Adherence in Veterans With and Without Psychiatric Disorders", Behavioral Sleep Medicine, 8(4), pp.260~273 (2010), Informa UK Limited[DOI]
- Brin YS, "Determinants af-fecting initiation of continuous positive airway pressure treatment", Isr Med Assoc J, 7, pp.13~18 (2005)
- Craig Phillips, "Hypertension and obstructive sleep apnea", Nature and Science of Sleep, 5, pp.43~52 (2013), Informa UK Limited[DOI]
- Craig L. Phillips, "Continuous positive airway pressure reduces postprandial lipidemia in obstructive sleep apnea: a randomized, placebo-controlled crossover tri-al", American Journal of Respiratory and Critical Care Medicine, 184(3), pp.355~361 (2011), American Thoracic Society[DOI]
- Takatoshi Kasai, "Sleep Apnea and Cardiovascular Disease", Circulation, 126(12), pp.1495~1510 (2012), Ovid Technologies (Wolters Kluwer Health)[DOI]
- Walter T. McNicholas, "Obstructive Sleep Apnea and Inflammation", Progress in Cardiovascular Diseases, 51(5), pp.392~399 (2009), Elsevier BV[DOI]
- Fouzia Siddiqui, "Half of patients with obstructive sleep apnea have a higher NREM AHI than REM AHI", Sleep Medicine, 7(3), pp.281~285 (2006), Elsevier BV[DOI]
- M. Jeffery Mador, "Prevalence of Positional Sleep Apnea in Patients Undergoing Polysomnography", Chest, 128(4), pp.2130~2137 (2005), Elsevier BV[DOI]