B37-04 Differences in Access to CPAP Treatment for Obstructive Sleep Apnea (OSA) in Europe

Several tens of millions of patients living with OSA are treated by CPAP across Europe. In the absence of EU guidelines, heterogeneity is huge between countries regarding criteria for CPAP prescription and patients’ management pathways, resulting in marked differences in access to CPAP treatment Methods Comparisons of access to CPAP therapy, indications, prescribers were performed from national practice guidelines, reimbursement policies and an expert survey in 11 countries. Results The proportion of individuals treated with CPAP related to the country’s population aged 18+ years ranged from 0.12% in Romania to 3.14% in France (Figure 1). Heterogeneity in CPAP treated patients can be partly explained by heterogeneities regarding criteria to prescribe CPAP and authorized prescribers. Apnea-Hypopnea Index (AHI), symptoms and comorbidities are considered in CPAP indication in most countries with heterogeneity in criteria definitions: 6 countries allow CPAP treatment for mild AHI (5-15) if associated with symptoms, accidental risk or comorbidities. Most countries require sleep certification for the center or the physician to prescribe CPAP. Pulmonologists are authorized CPAP prescribers in 11 countries, neurologists in 9, cardiologists in 7. Medical guidelines lack clear criteria for CPAP therapy discontinuation. Reimbursement policies vary, with some countries ceasing coverage for non-adherence (Belgium, Netherlands, Germany and some Italian/Spanish regions), while others leave the decision to physicians. Conclusion Significant heterogeneity in CPAP prevalence across Europe could be explained by different clinical indications, authorized prescribers and dereimbursement criteria. It highlights the need to develop clinical practice European guidelines and to harmonize the reimbursement modalities to optimize OSA management, patient outcomes and improve equity in care delivery.