Barriers to the diagnosis and treatment of obstructive sleep apnea in 15 francophone Sub-Saharan African countries: A multicountry survey.

Abstract

Purpose: Obstructive sleep apnoea (OSA) is underdiagnosed and undertreated in low-resource settings. This study aimed to comprehensively assess the availability, accessibility, and affordability of diagnostic and therapeutic resources for OSA across 15 francophone sub-Saharan African (FSSA) countries.

Methods: A cross-sectional survey was conducted from October to December 2025 under the coordination of the Société Africaine de Pneumologie de Langue Française (SAPLF). National experts from 15 countries were purposefully selected through the SAPLF network and completed a standardized questionnaire covering infrastructure, costs, workforce, insurance coverage, and perceived barriers. Quantitative data were analyzed descriptively; qualitative responses were analyzed thematically.

Results: Polysomnography (PSG) was available in 6/15 countries (40%) and respiratory polygraphy (RP) in 13/15 (86.7%), primarily concentrated in capital cities and private centers. Diagnostic costs were prohibitive: PSG ranged from €221-686 and RP from €69-259, often exceeding the statutory monthly minimum wage (SMW). Continuous positive airway pressure (CPAP) devices were available in 8/15 countries (53.3%) and mandibular advancement devices (MAD) in 5/15 (33.3%), with costs ranging from €381-3,812 and €38-305, respectively. Insurance coverage for CPAP was partial and reported in only three countries. The density of trained practitioners was critically low, with most countries reporting fewer than two per million inhabitants.

Conclusion: OSA care in francophone sub-Saharan Africa is constrained by centralised diagnostic capacity, prohibitive costs, and a shortage of trained providers. Strengthening training, reducing financial barriers, and integrating sleep medicine into non-communicable disease strategies may improve equity in access.