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Figure.  Craigslist Search Results
Craigslist Search Results

Results of searches on Craigslist.org for advertisements for continuous positive airway pressure devices, searching once per week for 4 consecutive weeks, in 18 US cities and geographic areas. Number of sleep clinics in each area also included. Tri-Cities indicates Bristol, Tennessee and Bristol, Virginia; Johnson City, Tennessee; and Kingsport, Tennessee.

Table.  Characteristics of 270 Online Advertisements for CPAP Devices in 18 Areas of the United States, October 2014
Characteristics of 270 Online Advertisements for CPAP Devices in 18 Areas of the United States, October 2014
1.
Giles  TL, Lasserson  TJ, Smith  BH, White  J, Wright  J, Cates  CJ.  Continuous positive airways pressure for obstructive sleep apnoea in adults.  Cochrane Database Syst Rev. 2006;(3):CD001106.PubMedGoogle Scholar
2.
Simon-Tuval  T, Reuveni  H, Greenberg-Dotan  S, Oksenberg  A, Tal  A, Tarasiuk  A.  Low socioeconomic status is a risk factor for CPAP acceptance among adult OSAS patients requiring treatment.  Sleep. 2009;32(4):545-552.PubMedGoogle Scholar
3.
United States Code of Federal Regulations, 21 CFR §868.5905 (2015).
4.
Gilmartin  GS, Daly  RW, Thomas  RJ.  Recognition and management of complex sleep-disordered breathing.  Curr Opin Pulm Med. 2005;11(6):485-493.PubMedGoogle ScholarCrossref
5.
Fogel  J, Zidile  C.  Contact lenses purchased over the internet place individuals potentially at risk for harmful eye care practices.  Optometry. 2008;79(1):23-35.PubMedGoogle ScholarCrossref
6.
American Sleep Apnea Association. CPAP assistance program. http://www.donatedcpap.org. Accessed June 14, 2016.
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    1 Comment for this article
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    Secondhand CPAP devices
    AESchneider, RRT | None
    Since there are so many devices for sale and being purchased it would cause the thought ... maybe the consumer cannot afford the high cost of buying a new item when the consumer does not have insurance or has a high deductible. If there were not a need there would not be any ads. It is my opinion that there are many consumers that cannot afford to buy new units. I know individuals that have a prescription and sleep study report but they cannot afford to buy a new CPAP/BiPAP unit. Sadly there maybe those that would sell a defective unit. But there are many others that have a perfectly good units and they are being sold at a reasonable price. There is a very large demand for quality used medical equipment. To stop this used market would do nothing but hurt those that need the service/equipment the most.
    CONFLICT OF INTEREST: None Reported
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    Research Letter
    October 2016

    Unauthorized Online Sales of Secondhand Continuous Positive Airway Pressure Devices

    Author Affiliations
    • 1Neuroscience Program, Psychology Department, University of St Thomas, St Paul, Minnesota
    • 2Section of Pulmonary, Critical Care, and Sleep, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota
    • 3Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Minnesota, Minneapolis
    JAMA Intern Med. 2016;176(10):1559-1561. doi:10.1001/jamainternmed.2016.4506

    Continuous positive airway pressure (CPAP) devices are used to treat obstructive sleep apnea and can improve patients’ blood pressure, reaction times while driving, and quality of life.1 Health insurance generally covers CPAP devices, but the typical cost of $600 to $2000 for patients without insurance or with minimal coverage can be prohibitive.2

    In the United States, CPAP devices require a prescription for purchase. According to the US Food and Drug Administration, CPAP devices are Class II medical devices with possible risks.3 Although the US Food and Drug Administration does not authorize sales of secondhand CPAP devices, such devices are bought and sold by private individuals.

    Methods

    Between October 1 and 31, 2014, we searched Craigslist.org, a classified advertisements website, weekly in 18 US cities and regions (Figure). We chose the locations to provide a range of geographic locations, median incomes, population densities, and number of sleep clinics. We searched for the term CPAP and extracted information from each advertisement, including reason for sale, price, hours of previous use, safety and medical content included with the CPAP device, and whether the need for a prescription was mentioned. We used 2014 US Census data for information on population and median income and the 2014 Yellow Pages for information on the number of sleep clinics in a given area. We calculated Pearson correlation coefficients with IBM SPSS Statistics, version 22.0 (IBM Corp). On May 22, 2015, we placed an online posting on Craigslist.org in each of the 18 cities and areas to anonymously survey CPAP buyers, and we sent email invitations to 10 randomly selected CPAP sellers in each of the 18 cities and areas (total of 180 emails), inviting them to complete an anonymous online survey. The University of St Thomas Institutional Review Board approved this study and waived the requirement of informed consent.

    Results

    We found 270 advertisements for secondhand CPAP devices (Table and Figure). The number of advertisements per area was positively correlated with population (r = 0.70; P = .001), number of sleep clinics (r = 0.50; P = .04), and median income (r = 0.53; P = .03).

    Most advertisements did not describe who had used the device (212 [78.5%]), why the device was being sold (221 [81.9%]), or the pressure setting of the device (232 [85.9%]) (Table). According to the advertisements, 165 devices (61.1%) included a used mask without information about the mask’s age or cleaning procedures, and 200 (74.1%) included a picture of the device and mask. The mean listed price was $291; a total of 235 devices (87.0%) were $500 or less. Only 5 advertisements (1.9%) mentioned the requirement for a prescription for the CPAP device.

    Our online postings to potential buyers were all flagged as inappropriate by users of the site; the postings were removed within 48 hours. We received no responses to our emails to randomly selected sellers.

    Discussion

    Secondhand CPAP devices are frequently available for sale on a classified advertisements website, at prices that are generally far below full retail cost, and without mention of the need for a prescription. We were unable to obtain information about individual buyers and sellers, such as how many advertisements resulted in a sale, what percentage of buyers had diagnosed and symptomatic obstructive sleep apnea, and patient outcomes.

    Unauthorized online sales of secondhand CPAP devices raise questions about safety and efficacy. Patients require individualized pressure settings for the CPAP device; a secondhand device may deliver a low pressure that is ineffective or a high pressure that is excessive, leading to discomfort or even central sleep apnea events.4 The use of auto-titrating devices that were specified in 27 advertisements (10.0%) may mitigate these problems but do not eliminate other concerns, such as the hygiene of secondhand devices and masks. Similar concerns have been raised about unauthorized online sales of contact lenses.5 Nonetheless, increasing access to low-cost CPAP devices has benefits, especially when the devices are hygienic, in good working order, and might otherwise be discarded.

    An alternative to consumer-to-consumer online sales is the American Sleep Apnea Association’s CPAP Assistance Program,6 with which we are not affiliated. This program accepts donations of used CPAP devices in good condition, and cleans and reprograms them based on the patient’s prescription. The charge for the device is $100, much less than the mean price of $291 that we found. For patients with obstructive sleep apnea and limited resources, similar programs should be encouraged and supported.

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    Article Information

    Corresponding Author: Ken M. Kunisaki, MD, MS, Pulmonary, Critical Care, and Sleep (111N), Minneapolis Veterans Affairs Health Care System, One Veterans Drive, Minneapolis, MN 55417 (kunis001@umn.edu).

    Published Online: August 8, 2016. doi:10.1001/jamainternmed.2016.4506

    Author Contributions: Ms Peine and Dr Prichard had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

    Study concept and design: All authors.

    Acquisition, analysis, or interpretation of data: All authors.

    Drafting of the manuscript: Peine, Kunisaki.

    Critical revision of the manuscript for important intellectual content: All authors.

    Statistical analysis: Peine.

    Administrative, technical, or material support: Prichard.

    Study supervision: Prichard, Kunisaki.

    Conflict of Interest Disclosures: None reported.

    Funding/Support: The US Department of Veterans Affairs, Veterans Health Administration, and Office of Research and Development provided protected research time to Dr Kunisaki in support of this study.

    Role of the Funder/Sponsor: The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

    Disclaimer: The views expressed in this article are those of the authors and do not reflect the views of the Department of Veterans Affairs, the US government, or any of the authors’ affiliated institutions.

    References
    1.
    Giles  TL, Lasserson  TJ, Smith  BH, White  J, Wright  J, Cates  CJ.  Continuous positive airways pressure for obstructive sleep apnoea in adults.  Cochrane Database Syst Rev. 2006;(3):CD001106.PubMedGoogle Scholar
    2.
    Simon-Tuval  T, Reuveni  H, Greenberg-Dotan  S, Oksenberg  A, Tal  A, Tarasiuk  A.  Low socioeconomic status is a risk factor for CPAP acceptance among adult OSAS patients requiring treatment.  Sleep. 2009;32(4):545-552.PubMedGoogle Scholar
    3.
    United States Code of Federal Regulations, 21 CFR §868.5905 (2015).
    4.
    Gilmartin  GS, Daly  RW, Thomas  RJ.  Recognition and management of complex sleep-disordered breathing.  Curr Opin Pulm Med. 2005;11(6):485-493.PubMedGoogle ScholarCrossref
    5.
    Fogel  J, Zidile  C.  Contact lenses purchased over the internet place individuals potentially at risk for harmful eye care practices.  Optometry. 2008;79(1):23-35.PubMedGoogle ScholarCrossref
    6.
    American Sleep Apnea Association. CPAP assistance program. http://www.donatedcpap.org. Accessed June 14, 2016.
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