P020 Socioeconomic indicators and PAP therapy use in adults with OSA

Introduction Obstructive sleep apnoea (OSA) is a highly prevalent sleep disorder with adverse impacts to the individual, the community, and healthcare systems. Although positive airway pressure (PAP) therapy is the gold standard treatment for OSA, sustained use remains a challenge. Therefore, it is important to understand the factors associated with PAP usage. The aim of this study was to explore and synthesise evidence on the direct associations between socioeconomic indicators and PAP therapy use in adults with OSA. Methods A scoping review following PRISMA-ScR protocol was conducted. Databases included PubMed, PsycINFO, CINAHL, and Cochrane. Each database was searched for studies published in the last 35 years with key words associated with OSA, PAP use, and socioeconomic indicators of education, income, employment status, occupational prestige, and neighbourhood advantage. Data were extracted on the strength and direction of relationship between socioeconomic factors and PAP therapy use. Results For the analysis 42 studies were included. The majority of evidence suggested no direct association of PAP therapy use with individual indicators of education and employment status. There was emerging evidence to suggest a positive relationship between PAP use and non-professional occupations, income, and neighbourhood advantage. Discussion There may be some justification to target socially disadvantaged people with interventions to promote PAP use. Future research could move beyond direct associations between PAP use and socioeconomic indicators, and explore a cumulative risk index, given that belonging to multiple inequitable groups can increase risk of low treatment adherence.