- CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP) IS THE TREATMENT OF CHOICE FOR PATIENTS WITH OBSTRUCTIVE SLEEP APNEA SYNDROME (OSAS). IF used on a regular basis, CPAP can effectively reduce the apnea-hypopnea index (AHI), decrease daytime sleepiness,1,2 improve sleep quality and quality of life for both the patient and partner,3 and reduce the risk of cardiovascular events.4–6 Despite the increase in CPAP treatment options (i.e., bilevel positive airway pressure, autoadjusting CPAP), treatment acceptance and adherence are low. It has been estimated that 15% to 30% of patients do not accept CPAP treatment from the outset.7 The decision to embrace CPAP occurs during the first few days of treatment.3,8–10 The issues influencing CPAP acceptance (or non-acceptance) are complicated, involving behaviors by the physician, patient, and health care system. Currently, no single factor has been consistently identified as predictive of CPAP acceptance and adherence.1,10,11–17 CPAP support programs and patient education increase patient acceptance during treatment initiation,18–20 since they improve patients' symptoms and their perception about CPAP treatment, driving patients to seek therapy.19–21 Little is known about the role of socioeconomic status (SES), determined by income level,22–24 on the decision to accept CPAP treatment. Patients with OSAS25 and people with low SES have higher rates of obesity, glucose intolerance, and cigarette smoking.4,6,26,27 Health literacy among low SES patients was found to be a barrier to treating obesity and managing cardiovascular disease (CVD).22,24,28–30 Patients with lower SES have a greater likelihood of exposure to SES risk behaviors, including nonattendance for health checkups and poor compliance, resulting in increased CVD morbidity and mortality risk.24,27 Patients with OSAS recruited from hospitals serving low SES neighborhoods,28 compared with hospitals serving high SES populations, had a greater body mass index (BMI) and more comorbidity, despite similar demographics. Forty-two percent of patients with OSAS from hospitals serving minority groups failed to follow up for CPAP treatment, compared with 7% in the voluntary hospital group.28 This finding may be related to health literacy and low SES behavior. It is possible that the poor compliance with various interventions may impair treatment acceptance among low-SES OSA patients requiring CPAP. The aim of the study was to evaluate whether SES is an independent factor affecting CPAP acceptance to commence (purchase) treatment.