Gender differences in the preference for upper airway stimulation therapy among Japanese patients with obstructive sleep apnea already treated with continuous positive airway pressure

Abstract

Although upper airway stimulation (UAS) is becoming an established therapy for obstructive sleep apnea (OSA) in Western countries, it is not available in Japan, where invasive procedures tend to be avoided, especially by women. We, therefore, performed surveillance concerning the preference for UAS among Japanese OSA patients receiving CPAP treatment. Preference for UAS and the reasons were obtained from responses to an original questionnaire administered to 101 CPAP users. We also obtained polysomnography parameters and the current CPAP use data to determine adherence and pressure and evaluated the relationship between such factors and the preference. Among 101 patients (mean age 59.1 ± 13.1 years old, men 75.2%, mean body mass index 28.2 ± 6.1 kg/m2, mean apnea–hypopnea index at the diagnosis 51.7 ± 24.4/h, mean usage time per day 4.9 ± 2.3 h/day), 21 patients (20.8%; M/F = 15/6) were willing to use UAS, while 57 (56.5%; M/F = 43/14) were unwilling, and 23 (22.7%; M/F = 18/5) showed neutral preference. The proportion of patients who preferred UAS did not differ significantly among age groups. We found no significant factors independently affecting the preference. However, in the group willing to use UAS, the rate of days when CPAP usage exceeded 4 h per month was an independent negative factor predicting the preference only among women in a multivariable analysis (odds ratio 0.96, 95% confidence interval 0.92–1.00, p = 0.04). About 20% of patients showed a positive attitude toward UAS treatment among current Japanese CPAP users, and CPAP adherence was an independent negative factor predicting preference among women.