Improved Adherence to Positive Airway Pressure Treatment after Covering National Health Insurance in Patient with Obstructive Sleep Apnea: A Tertiary Sleep Center Review

초록

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.

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