Objective: The aim of this study was to analyze the frequency of initiation of continuous positive airway pressure (CPAP) in patients with obstructive sleep apnea syndrome (OSAS) in a referral hospital in Mexico City serving mainly patients without public health insurance coverage and to assess their level of adherence.
Patients and methods: Patients with OSAS diagnosed by polysomnography or by simplified respiratory polygraphy for whom nasal CPAP was prescribed were enrolled in the study. Titration of CPAP was performed during polysomnography or with an automatic CPAP device. Compliance with treatment was assessed during a medical visit or by telephone interview.
Results: A total of 304 patients were enrolled upon prescription of nasal CPAP; 169 (55.5%) either purchased a device or were provided with one by the social security system. The patients most seriously ill and who had public health insurance coverage were the ones who most often acquired a device. These patients took 1.5 months to obtain the equipment and had a compliance rate of 80% at a mean 34 months of follow-up. The respiratory events index was correlated with compliance, whereas excessive daytime sleepiness (Epworth scale score) and body mass index were predictors of therapeutic CPAP pressure.
Conclusions: Nearly half the patients who were prescribed CPAP did not acquire the device. Most of those who acquired a device adhered to the treatment. In Mexico access to procedures for diagnosing OSAS is limited and access to treatment is also restricted for patients who do not have public health insurance coverage.