Barriers to CPAP Use in India: An Exploratory Study.

STUDY OBJECTIVES: To investigate adherence to continuous positive airway pressure (CPAP) therapy and identify barriers to CPAP use among patients with obstructive sleep apnea (OSA) in India.

METHODS: A self-devised semistructured questionnaire (which collected patients' demographic information, socioeconomic position, and information about disease status, symptoms, and complications) was administered to consecutive patients with moderate to severe OSA from June 2015 to August 2016. Patients were grouped according to CPAP device buying behavior (buyers versus nonbuyers) and CPAP compliance behavior (compliant versus noncompliant).

RESULTS: Out of 187 patients with moderate-severe OSA, 79 patients were enrolled for this study. The overall adherence rate (usage > 4 hours per night on > 70% nights) was 30.3%. Among the patients in the buyer group, adherence was 82.7%. Fifty patients did not buy a CPAP device; 30 of these 50 patients (60%) said financial constraints were the most important reason for not buying a CPAP device. Patients without financial constraints had higher chances-odds ratio (95% confidence interval) = 4.85 (1.6-16.1)-of buying a CPAP device than patients with financial constraints. Patients with more severe disease (ie, lower nadir oxygen saturation during sleep, higher apnea-hypopnea index, or presence of obesity hypoventilation syndrome) were more likely to buy and use a CPAP device.

CONCLUSIONS: The main cause of nonuse of CPAP in India is the inability to buy a CPAP device. In patients who are able to buy a CPAP device, adherence was significantly higher (82.7%) compared to adherence in the study's overall population (30.3%). Furthermore, patients with more severe OSA were more likely to buy a device and adhere to CPAP. Patients' behaviors and attitudes are also important barriers in using CPAP. There needs to be increased awareness of the benefits of CPAP therapy among patients.