Socio-Economic Status: A Barrier to Access to Mandibular Advancement Device Therapy for Patients with Obstructive Sleep Apnea Syndrome in France

Obstructive sleep apnea syndrome (OSAS) is a major public health problem which affects between 5 to 10% of the general population. OSAS is known to be associated with high rates of morbidity and mortality mainly due to cardiovascular diseases and traffic accidents. The burden of illness is high for...

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Bibliographic Details
Published in:PloS one 2015-09, Vol.10 (9), p.e0138689-e0138689
Main Authors: Fleury, Marion, Le Vaillant, Marc, Pelletier-Fleury, Nathalie
Format: Article
Language:English
Subjects:
Angina pectoris
Apnea
Cardiovascular disease
Cardiovascular diseases
Chronology
Continuous Positive Airway Pressure
Dental care
Dentists
Economic aspects
Economics
Female
France
Health aspects
Health care
Health care access
Heart diseases
Humans
Hygiene
Male
Mandible
Mandibular Advancement - instrumentation
Middle Aged
Morbidity
Multivariate Analysis
Occupational health
Oral hygiene
Patients
Population
Public health
Regression Analysis
Respiratory tract
Risk factors
Sleep
Sleep apnea
Sleep Apnea, Obstructive - surgery
Sleep disorders
Social Class
Socioeconomic factors
Socioeconomics
Technicians
Teeth
Therapy
Traffic accidents
Traffic accidents & safety
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Summary:Obstructive sleep apnea syndrome (OSAS) is a major public health problem which affects between 5 to 10% of the general population. OSAS is known to be associated with high rates of morbidity and mortality mainly due to cardiovascular diseases and traffic accidents. The burden of illness is high for the individual and society. There are 2 treatment options for OSAS, Continuous Positive Airway Pressure (CPAP) and Mandibular Advancement Device therapy (MAD). CPAP is known to be an effective but very constraining treatment. Patients are usually poorly adherent. MAD is a more recent treatment easier to use and consequently better tolerated, but MAD can only be prescribed to patients with satisfactory oral hygiene. Oral health constitutes a real issue particularly among underprivileged groups in France. Through this link, the question of whether low socio-economic status constitutes a barrier to access to care for patients with OSAS is raised. In a multicenter prospective cohort of 2822 consecutive OSAS patients in whom MAD has been proposed as an alternative to CPAP between May 15, 2007 and December 1st, 2014, we identified the factors that lead to a patient diagnosed with OSAS to be treated by MAD instead of CPAP. A logistic regression was performed using a stepwise forward procedure. The main outcome of the study was that treatment by MAD was significantly associated with both educational attainment, as determined by the age at which the patient left full-time education, ≥18 years compared with
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0138689