Sociodemographic and Healthcare System Barriers to PAP Alternatives for Adult OSA: A Scoping Review

Amritpal Singh; Amrita Bhat; Jasmeet Saroya; Jolie Chang; Megan L Durr

doi:10.1002/lary.31429

Sociodemographic and Healthcare System Barriers to PAP Alternatives for Adult OSA: A Scoping Review

Laryngoscope. 2024 Apr 3. doi: 10.1002/lary.31429. Online ahead of print.

Authors

Amritpal Singh^{1

2}, Amrita Bhat², Jasmeet Saroya^{1

2}, Jolie Chang^{2

3}, Megan L Durr²

Affiliations

¹ School of Medicine, University of California San Francisco, San Francisco, California, U.S.A.
² Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California, U.S.A.
³ Surgical Services, San Francisco Veterans Affairs Health Care System, San Francisco, California, U.S.A.

PMID: 38568079
DOI: 10.1002/lary.31429

Abstract

Objective: To investigate sociodemographic and healthcare system barriers to access and utilization of alternative treatments to positive airway pressure (PAP) in the management of adult obstructive sleep apnea (OSA).

Data sources: PubMed, Embase, and Web of Science databases were searched from 2003 to 2023 for English-language studies containing original data on sociodemographic and healthcare system barriers to PAP-alternative treatments for adult OSA.

Review methods: Studies were assessed using the Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. Title and abstract screening, full-text review, and data collection were conducted by two investigators independently.

Results: Out of 1,615 studies screened, 13 studies met inclusion criteria and reported on a total of 1,206,115 patients who received PAP alternative treatments, including surgery (n = 9 studies), and oral appliances (OAs) (n = 3 studies). The chance of receiving a PAP-alternative treatment such as surgery was greater among patients aged 39 years or younger, had body mass index below 30 kg/m², fewer comorbidities, private insurance, and a higher occupational and income status. The decision of individuals to receive PAP alternative treatments was influenced by increased patient education from providers, as well as improvements in daytime sleepiness and partner perception of snoring and apnea.

Conclusion: Cumulative evidence suggests that several sociodemographic and healthcare system factors are associated with decreased use of PAP alternatives when PAP therapy fails. Investigation of interventions to eliminate these potential barriers may improve access and treatment outcomes. Laryngoscope, 2024.

Keywords: CPAP therapy; Sociodemographic barriers; healthcare system barriers; mandibular reconstruction; obstructive sleep apnea; oral appliances; sleep apnea; surgery; surgical treatment of obstructive sleep apnea.

Publication types

Review