Race and Residential Socioeconomics as Predictors of CPAP Adherence

Billings, Martha E.; Auckley, Dennis; Benca, Ruth M.; Foldvary‐Schaefer, Nancy; Iber, Conrad; Redline, Susan; Rosen, Carol L.; Zee, Phyllis C.; Kapur, Vishesh K.

doi:10.5665/sleep.1428

Cited by 163 publications

(157 citation statements)

References 33 publications

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“…13,20,[44][45][46][47][48] Our data, which include subjects with a wide range of SDB severity and sleepiness as well as wide ranging racial and gender distribution, are in agreement with studies that showed no relationship between these demographic variables and short-term or long-term CPAP use. In our dataset with 27% Black subjects, we failed to show a difference in ST CPAP adherence based on race (Black subjects: 3.2 ± 2.0 h/night vs White subjects: 3.2 ± 2.4 h/night, p = 0.99).…”

Section: 3839supporting

confidence: 74%

“…In our dataset with 27% Black subjects, we failed to show a difference in ST CPAP adherence based on race (Black subjects: 3.2 ± 2.0 h/night vs White subjects: 3.2 ± 2.4 h/night, p = 0.99). Other studies have showed significantly reduced CPAP adherence in black subjects, 30,46,47 although most of these studies did not report socioeconomic status, which has been shown to be an independent predictor of CPAP adherence regardless of race.…”

Section: 3839mentioning

confidence: 87%

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Sleep Quality, Short-Term and Long-Term CPAP Adherence

Somiah

Taxin

Keating

et al. 2012

Journal of Clinical Sleep Medicine

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S C I E N T I F I C I N V E S T I G A T I O N SU ntreated obstructive sleep apnea/hypopnea syndrome (OSAHS) signifi cantly affects quality of life and cardiovascular/cerebrovascular morbidities and mortality.1-4 CPAP therapy has been shown to be effective in treating sleep disordered breathing (SDB) by reducing the apnea/hypopnea index (AHI) 5 and by reducing excessive daytime somnolence (EDS). 6Despite this, CPAP acceptance and adherence are disappointingly low. A signifi cant number of patients (ranging from 30% to 80% in various studies) demonstrate an average CPAP usage of less than 4 hours per night. 7,8 Several reviews have emphasized the need to identify patients who are at the greatest risk for non-adherence, with the goal of developing techniques to maximize overall adherence. 9,10Studies have suggested that CPAP adherence can be correlated to characteristics of patients at baseline, such as the severity of OSAHS, 11-13 the level of EDS, 14 and anatomical factors (smaller nasal cross-sectional area, reduced nasal volume, and high nasal resistance 15,16 ), but the strength of these correlations has been weak. Drake et al. showed that patients whose sleep effi ciency on the CPAP titration night improved most had the greatest CPAP compliance at 47 days.17 More recently, studies using social cognitive theory 18-20 and health BRIEF SUMMARYCurrent knowledge/Study Rationale: Despite its efficacy, adherence to CPAP therapy is highly variable amongst patients with obstructive sleep apnea with large numbers of patients demonstrating inadequate adherence to CPAP. The present study is aimed at identifying early predictors of CPAP adherence from variables obtained at the time of diagnosis and titration of CPAP, thereby providing potential for early intervention. Study Impact: Our data show that better sleep quality (greater % REM) was seen in patients with higher CPAP adherence and confi rm that long term adherence was largely predicted by short term adherence. This suggests that interventions that improve sleep during or prior to the CPAP titration study may be useful in improving CPAP adherence.

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Section: 3839supporting

confidence: 74%

Section: 3839mentioning

confidence: 87%

Sleep Quality, Short-Term and Long-Term CPAP Adherence

Somiah

Taxin

Keating

et al. 2012

Journal of Clinical Sleep Medicine

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“…There is increasing evidence that African Americans have disproportionate failure rates following adenotonsillectomy for OSA in children and reduced rates of CPAP adherence for OSA in adults. 22,23 Other vulnerable groups have also been found to have lower CPAP adherence. 24 Little information is available regarding the success of specific OSA treatment options in South Asians.…”

Section: Sleep Apnea and Cardiometabolic Risk In South Asiansmentioning

confidence: 99%

Sleep Apnea and Cardiometabolic Risk in South Asians

Kandula

Patel

2013

Journal of Clinical Sleep Medicine

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“…The current standard of treatment for moderate to severe OSAS is positive airway pressure (PAP) therapy [2]. However, diagnosis and treatment methods are expensive, and often unaffordable to those that are economically challenged and/or uninsured [3,4,9]. Reports in the literature suggest that patients from lower SES backgrounds encounter barriers to diagnosis of OSAS and have lower therapy adherence rates [3,4,7,9].…”

Section: Introductionmentioning

confidence: 99%

Domiciliary continuous positive airway pressure therapy in an underserved population: compliance and influential factors

Burke¹,

Wells²,

Singh³

2014

Pulmonol Respir Res

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Obstructive sleep apnea syndrome is an increasingly recognized global epidemic [1]. Uninsured patients frequently lack access to specialized testing, treatment and specialists access. Such patients may have conflicting priorities that affect their ability to comply with sleep apnea therapy. Carolinas Sleep Services has an Ambulatory Sleep program in which uninsured patients in Mecklenberg County, NC are provided both diagnostic and treatment options at either no or minimal charge. We retrospectively reviewed the chart data for 236 patients at the Carolina Sleep Services Ambulatory Clinic to assess patient adherence to PAP therapy in this low-income population. 149 (63%) of the 236 patients were recommended to have positive airway pressure therapy; the remaining 87 patients were not recommended PAP therapies. Compliance reports were obtained for only 30 of the 149 patients; patients were not given CPAP devices with modems and the return of card data was a challenge. Of those with compliance reports, 14 (47%) were compliant with their therapy. However, since this study had severe limitations, further research into methods for improving therapeutic compliance in uninsured or low-income populations is suggested. Approaches for addressing PAP compliance in underserved populations may also be linked to broader issues of access to healthcare in this population.

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Race and Residential Socioeconomics as Predictors of CPAP Adherence

Cited by 163 publications

References 33 publications

Sleep Quality, Short-Term and Long-Term CPAP Adherence

Sleep Quality, Short-Term and Long-Term CPAP Adherence

Sleep Apnea and Cardiometabolic Risk in South Asians

Domiciliary continuous positive airway pressure therapy in an underserved population: compliance and influential factors

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