Rationale — Many studies have demonstrated the benefits of treating obstructive sleep apnea (OSA) with continuous positive airway pressure (CPAP). However, both recognition of OSA and acceptance of treatment are suboptimal. Current data on CPAP initiation at a population level is lacking.
Objective — The objectives were to determine the rate of CPAP initiations in Ontario, Canada (population ∼13 000 000), and to profile these individuals over time.
Methods — We conducted a population based cohort study between 2006 and 2013. All adults who initiated CPAP for OSA were included. Patient characteristics, comorbidities and health care utilization at the time of CPAP initiation were derived from provincial health administrative data. Changes in patient characteristics over time were assessed.
Results — 216,514 individuals initiated CPAP therapy over 8 years as compared to 802,188 individuals who underwent diagnostic polysomnography (PSG) during that time. The rate of new CPAP initiations increased from 18.6/10000 in 2006 to 28.7/10 000 in 2008 and then plateaued with an annual increase of less than 1/10 000 from 2008 to 2013. More women and middle aged (50+) individuals initiated CPAP as did more low income Ontarians. Comorbidities were common and the frequency of congestive heart failure, chronic kidney disease, and cancer increased during the study period.
Conclusions — Over an eight year period CPAP initiation appears to have plateaued in spite of increasing PSG testing; however, those receiving treatment with CPAP are increasingly complex and a greater proportion are women.