Abstract：
OBJECTIVE: To investigate sociodemographic and healthcare system barriers to access and utilization of alternative treatments to positive airway pressure (PAP) in the management of adult obstructive sleep apnea (OSA).
METHODS: PubMed, Embase, and Web of Science databases were searched from 2003 to 2023 for English-language studies containing original data on sociodemographic and healthcare system barriers to PAP-alternative treatments for adult OSA.
METHODS: Studies were assessed using the Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. Title and abstract screening, full-text review, and data collection were conducted by two investigators independently.
RESULTS: Out of 1,615 studies screened, 13 studies met inclusion criteria and reported on a total of 1,206,115 patients who received PAP alternative treatments, including surgery (n = 9 studies), and oral appliances (OAs) (n = 3 studies). The chance of receiving a PAP-alternative treatment such as surgery was greater among patients aged 39 years or younger, had body mass index below 30 kg/m2, fewer comorbidities, private insurance, and a higher occupational and income status. The decision of individuals to receive PAP alternative treatments was influenced by increased patient education from providers, as well as improvements in daytime sleepiness and partner perception of snoring and apnea.
CONCLUSIONS: Cumulative evidence suggests that several sociodemographic and healthcare system factors are associated with decreased use of PAP alternatives when PAP therapy fails. Investigation of interventions to eliminate these potential barriers may improve access and treatment outcomes. Laryngoscope, 134:3903-3909, 2024.
METHODS: PubMed, Embase, and Web of Science databases were searched from 2003 to 2023 for English-language studies containing original data on sociodemographic and healthcare system barriers to PAP-alternative treatments for adult OSA.
METHODS: Studies were assessed using the Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. Title and abstract screening, full-text review, and data collection were conducted by two investigators independently.
RESULTS: Out of 1,615 studies screened, 13 studies met inclusion criteria and reported on a total of 1,206,115 patients who received PAP alternative treatments, including surgery (n = 9 studies), and oral appliances (OAs) (n = 3 studies). The chance of receiving a PAP-alternative treatment such as surgery was greater among patients aged 39 years or younger, had body mass index below 30 kg/m2, fewer comorbidities, private insurance, and a higher occupational and income status. The decision of individuals to receive PAP alternative treatments was influenced by increased patient education from providers, as well as improvements in daytime sleepiness and partner perception of snoring and apnea.
CONCLUSIONS: Cumulative evidence suggests that several sociodemographic and healthcare system factors are associated with decreased use of PAP alternatives when PAP therapy fails. Investigation of interventions to eliminate these potential barriers may improve access and treatment outcomes. Laryngoscope, 134:3903-3909, 2024.
摘要：
目的：调查在成人阻塞性睡眠呼吸暂停（OSA）治疗中获得和使用气道正压（PAP）替代疗法的社会人口统计学和医疗保健系统障碍。
方法：PubMed，Embase,从2003年到2023年，在WebofScience数据库中搜索了英语研究，其中包含有关成人OSA的PAP替代治疗的社会人口统计学和医疗保健系统障碍的原始数据。
方法：使用系统评价的首选报告项目和范围评价的Meta分析扩展（PRISMA-ScR）指南对研究进行评估。标题和摘要筛选，全文回顾,数据收集由两名研究者独立进行.
结果：在筛选的1,615项研究中，13项研究符合纳入标准，共报告了1,206,115例接受PAP替代治疗的患者。包括手术（n=9项研究），和口腔矫治器（OAs）（n=3项研究）。在39岁或以下的患者中，接受PAP替代治疗如手术的机会更大，体重指数低于30kg/m2，合并症较少，私人保险,以及较高的职业和收入状况。个人接受PAP替代疗法的决定受到提供者增加的患者教育的影响，以及改善白天嗜睡和伴侣对打鼾和呼吸暂停的感觉。
结论：累积证据表明，当PAP治疗失败时，一些社会人口统计学和医疗保健系统因素与PAP替代品的使用减少有关。调查消除这些潜在障碍的干预措施可能会改善获得和治疗结果。喉镜,2024.
方法：PubMed，Embase,从2003年到2023年，在WebofScience数据库中搜索了英语研究，其中包含有关成人OSA的PAP替代治疗的社会人口统计学和医疗保健系统障碍的原始数据。
方法：使用系统评价的首选报告项目和范围评价的Meta分析扩展（PRISMA-ScR）指南对研究进行评估。标题和摘要筛选，全文回顾,数据收集由两名研究者独立进行.
结果：在筛选的1,615项研究中，13项研究符合纳入标准，共报告了1,206,115例接受PAP替代治疗的患者。包括手术（n=9项研究），和口腔矫治器（OAs）（n=3项研究）。在39岁或以下的患者中，接受PAP替代治疗如手术的机会更大，体重指数低于30kg/m2，合并症较少，私人保险,以及较高的职业和收入状况。个人接受PAP替代疗法的决定受到提供者增加的患者教育的影响，以及改善白天嗜睡和伴侣对打鼾和呼吸暂停的感觉。
结论：累积证据表明，当PAP治疗失败时，一些社会人口统计学和医疗保健系统因素与PAP替代品的使用减少有关。调查消除这些潜在障碍的干预措施可能会改善获得和治疗结果。喉镜,2024.
