Effect of National Health Insurance Coverage on Adherence to Positive Airway Pressure Therapy in Obstructive Sleep Apnea Patients

Abstract

Background and Objective Positive airway pressure (PAP) is considered a standard treatment for obstructive sleep apnea (OSA). Although PAP is effective in resolving upper airway collapse, a major challenge is maximizing adherence. Polysomnography and PAP have been included in Korean National Health Insurance (NHI) coverage since July 2018. This study was performed to investigate the adherence to PAP therapy according to the device manager after NHI coverage in OSA patients. Methods Between July 2018 and May 2020, a total of 211 patients were prescribed PAP in a single tertiary hospital, and the PAP devices were managed by two companies. Among them, 187 patients constituted the final study population. Assessment of adherence was performed at 3 and 12 months after initiating PAP therapy. Good adherence was defined as using a PAP device for ≥ 4 hours daily and on ≥ 70% of nights. Results Ninety-three patients used the PAP machine obtained from device manager A and 94 patients used the PAP machine obtained from device manager B. During 90 days, the total good adherence rate was 66.8% (n = 125). The good adherence rate for device manager A was 66.7% (62/93) and that for device manager B was 67.0% (63/94), which was not statistically different (p = 0.959). However, the good adherence rate at 1 year after initiating PAP therapy was 38.7% (36/93) for device manager A and 58.5% (55/94) for device manager B, which was statistically significant (p = 0.007). Conclusions The good adherence rate was decreased at 1 year after initiating PAP therapy despite NHI coverage. Furthermore, the device manager may play an important role in increasing the adherence rate in patients with OSA.

Keywords

• national health insurance; continuous positive airway pressure; sleep apnea
• obstructive; patient compliance; health personnel