Patient preferences for obstructive sleep apnea treatment attributes: a discrete choice experiment among CPAP users in Japan.

STUDY

OBJECTIVES

To quantify treatment attribute preferences among Japanese patients receiving continuous positive airway pressure (CPAP) therapy for obstructive sleep apnea (OSA), estimate willingness-to-pay (WTP), and examine preference heterogeneity by CPAP adherence status.

METHODS

We conducted a discrete choice experiment among 161 patients with CPAP-treated OSA at a Japanese community hospital (August-October 2025). Participants chose between hypothetical treatment profiles varying across five attributes: sleep quality improvement, device usage frequency, side effect severity, clinic visit frequency, and monthly cost. Preferences were analyzed using conditional logit models with Delta-method estimation of WTP. Preference heterogeneity by CPAP adherence (≥70% vs <70% of nights with ≥4 h use) was evaluated through stratified models and effect size analysis.

RESULTS

Sleep quality improvement dominated preferences (relative importance 42.4%; WTP ¥5298/month). Unexpectedly, patients showed negative preferences for reduced clinic visit frequency (WTP - ¥1232/month) and non-significant negative preference for side effect burden (WTP - ¥1474/month, p = .079). CPAP adherence was associated with large differences in preference weights (Hedges' g = 1.84-1.93 based on model coefficients); however, WTP comparisons between adherence groups were not statistically significant (all p > .17; post-hoc power: 6%-28%). These findings should be interpreted as exploratory, hypothesis-generating evidence warranting confirmation in larger studies.

CONCLUSIONS

Japanese patients with OSA prioritize treatment efficacy but value frequent healthcare contact, particularly among poor CPAP adherers who view clinic visits as essential support. Preliminary evidence suggests potentially distinct preference structures between adherence groups, warranting confirmation in larger, adequately powered studies. These findings support adherence-stratified care and preference-informed shared decision-making for OSA management.