Abstract
The aim of the present study was to compare the clinical findings and polysomnography results obtained at public and private clinics in Brazil, the follow-up after diagnosis, and the therapeutic aspects related to continuous positive airway pressure. Patients who snore and who have obstructive sleep apnea were retrospectively divided into two groups, i.e., public clinic (N=307) and private clinic (N=317). Data concerning age, sex, body mass index (BMI), neck circumference, medical history, sleepiness scale, follow-up after diagnosis, and acceptance of continuous positive airway pressure therapy were collected. Mean age was 50 +/- 12 (range: 15-80) for public patients and 48 +/- 12 years (range: 19-91) for private patients. Mean BMI was 30 +/- 6 (range: 19-67) for public patients and 31 +/- 6 kg/m (range: 21-59) for private patients. The public clinic had a significantly higher frequency of women than the private clinic (M:F ratio of 2.0:1 and 6.9:1, respectively). The condition of private patients (apnea-hypopnea index=31 +/- 25) was more severe than that of public patients (apnea-hypopnea index=25 +/- 24 events/h; P=0.0004). In the public and private clinics, 19 and 15% of patients were snorers, respectively, and 81 and 85% of them had sleep apnea. After diagnosis, follow-up was longer in the private group. The continuous positive airway pressure acceptance was similar for both groups (32 vs 35%), but patients from the public clinic abandoned treatment more than private ones (65 vs 13%). Social status was significant in terms of the severity of obstructive sleep apnea age and gender distribution. Private patients look for a diagnosis earlier in the course of the disease than public patients, adhere more to follow-up, and abandon continuous positive airway pressure treatment less than public patients do.
Highlights
Obstructive sleep apnea (OSA) is considered to be a medical and public health problem in terms of its consequences for the cardiovascular system and excessive daytime sleepiness, affecting mainly obese middle-aged individuals [1,2,3,4]
Demographic data, clinical findings, PSG features, and CPAP acceptance have not been previously compared between public and private clinics. Patients from these clinics mainly differ in economic status, a fact that can be highly relevant in terms of the principal treatment of sleep apnea considering the high cost of nasal CPAP
The data comparing public to private patients revealed a mean age of 50 ± 12 and 48 ± 12 years (P = 0.014), body mass index (BMI) of 30 ± 6 and 31 ± 6 kg/m2, neck circumference of 41 ± 5 and 43 ± 4 cm, respectively, with a predominance of men in both groups, and with the private clinic having a higher percent of men than the public (87 and 67%, respectively, P < 0.0001) (Table 1)
Summary
Obstructive sleep apnea (OSA) is considered to be a medical and public health problem in terms of its consequences for the cardiovascular system (high blood pressure and ischemic heart disease) and excessive daytime sleepiness (causing automobile accidents), affecting mainly obese middle-aged individuals [1,2,3,4]. The clinical and polysomnography (PSG) features of OSA patients are well-known in the literature, as are the indication of and compliance with nasal CPAP [9,10,11] Some individual aspects such as obesity, gender, age, ethnicity, smoking, and alcohol use are closely related to OSA [12,13,14,15,16,17,18]. Demographic data, clinical findings, PSG features, and CPAP acceptance have not been previously compared between public and private clinics Patients from these clinics mainly differ in economic status, a fact that can be highly relevant in terms of the principal treatment of sleep apnea considering the high cost of nasal CPAP
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