Commercial Motor Vehicle Driver Positive Airway Pressure Therapy Adherence in a Sleep Center

Abstract

Study Objectives: To assess positive airway pressure (PAP) therapy adherence in commercial motor vehicle (CMV) drivers presenting to a sleep center. Methods: A retrospective chart review of 120 drivers evaluated for obstructive sleep apnea OSA and 53 initiated on PAP therapy in a single sleep center over a one-year period (2012); PAP therapy data were collected up to 1 year. Results: Early PAP usage best predicted adherence up to 1 year (p < 0.0001) compared to patient factors, OSA disease characteristics, and treatment elements analyzed. The proportion of participants adherent to therapy was 68.0% at 1 week, decreasing to 39.6% at 1 year, with 31.1% lost to follow-up by 1 year. In the group categorized based on adherence at week 1, 80.6% were adherent at 1 month, decreasing to 52.8% at 1 year. For the group non-adherent at 1 week, 29.4% were adherent at 1 month, decreasing to 11.7% at 1 year. Participants were predominantly male (75.8%), middle-aged (median 50.5 years), and African American (71.7%). Of those referred to the sleep center, 86.7% had OSA (median apnea-hypopnea index [AHI] or respiratory event index [REI] 20.1), with 51.0% of the OSA group having an AHI or REI > 20 and initiating PAP therapy. Conclusions: Early PAP utilization patterns predicted one year adherence for our CMV driver population within a sleep clinic setting. OSA testing of these CMV drivers after occupational health referral identifies high proportions of undiagnosed OSA, with approximately half requiring PAP therapy based on current published treatment recommendations. Keywords: obstructive sleep apnea, commercial motor vehicle, driver, sleep apnea, positive airway pressure, continuous positive airway pressure, adherence, Federal Motor Carrier Safety Administration Citation: Colvin LJ, Dace GA, Colvin RM, Ojile J, Collop N. Commercial motor vehicle driver positive airway pressure therapy adherence in a sleep center.

Racial disparities in positive airway pressure therapy adherence among veterans with obstructive sleep apnea

“…Multiple studies, however, have shown correlation between adherence from as early as 3-7 days with later adherence at 1, 3, and 6 months, and 1 year. 23,[40][41][42] Finally, although we identified an association between black race and PAP adherence, the retrospective study design did not allow us to determine the basis for the observed relationship. Studies have shown a higher prevalence of insomnia and short sleep duration among black adults, 43,44 and it is unknown if these factors or other confounders explain the racial disparity that was seen.…”

Adherence to positive airway pressure treatment among minority populations in the US: A scoping review

“…In another cohort study focusing on the relationship between pre­treatment sleep schedule regularity and PAP adherence [25], Sawyer et al did not identify significant black-white differences in frequency of one month treatment adherence (within-group % ≥ 4 hrs daily adherence, 83% [black] vs 60% [white]; p=0.40 ). Similarly, Colvin et al did not identify significant race-ethnic PAP use differences in a study of individuals referred to a sleep center for commercial motor vehicle driver evaluations [35], though this sample may not be reflective of general clinical sleep center populations. In this study, blacks had non-significant (p = 0.11) higher frequency of adequate PAP adherence (≥ 4 hrs daily on ≥ 70% days) than whites at one week (72% vs 28%), 1 month (74% vs 27%), 3 months (70% vs 30%), and 12 months (76% vs 24%).…”