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

Abstract

Study Objectives: Black individuals are disproportionately affected by diabetes, cardiovascular disease, obesity, and OSA. Adherence to PAP therapy has been reported to be lower among black individuals. This study seeks to examine associations between black race and PAP adherence among veterans with OSA. Methods: This was a retrospective study. Veterans newly diagnosed with OSA at a single Department of Veterans Affairs sleep center who were prescribed a modem-enabled PAP device between January 2015 and November 2017 were enrolled. PAP adherence was defined as ≥ 4 hours nightly usage for at least 70% of nights measured at 30 days from PAP setup. We examined the relationship between race and adherence, controlling for sex, marital status, age, socioeconomic status, residual apnea-hypopnea index), and mask leak. Results: Of 3013 patients identified with OSA, 2571 (85%) were newly started on PAP therapy (95% male, aged 59 years ± 14 years, 45% married, 8% with neighborhood socioeconomic disadvantage). Twenty-five percent of participants were black, and 57% were white. PAP adherence at 30 days was 50% overall (42% among blacks, 53% among nonblacks). Black race was associated with reduced 30-day PAP adherence in unadjusted (P <.001) and adjusted logistic regression models (odds ratio = 0.64; 95% CI, 0.53 -0.78; P < .001). Conclusions: Among veterans with OSA, black race was associated with reduced PAP adherence. These findings suggest health inequality among black individuals in the treatment of OSA.

Sleep apnea in women veterans: results of a national survey of VA health care users

“…44 A more recent study of veterans who received treatment in a VA sleep disorders center found that Black race was associated with less PAP use (compared to White race) over the first 30 days of treatment, but again, the study sample was 95% male veterans. 45 We did not find differences in PAP use among women veterans based on racial/ ethnic identity. Another study found worse PAP adherence in younger women (ages 18-30) compared to women in other age ranges and compared to men in a national sample, 46 but age was not different in users and nonusers of PAP in our study.…”

Obstructive sleep apnea in older adults: geographic disparities in PAP treatment and adherence

“…7,8 In older adults with OSA, the proportions of PAP treated and PAP adherent are estimated between 60% and 73%. [9][10][11] Sociodemographic and health factors have been linked to OSA treatment gaps, 10,12,13 but data on regional OSA disparities in the United States are scarce. 14 Geographic differences have been reported in other chronic conditions such as metabolic syndrome and stroke recurrence and mortality, with the highest burden observed in central US states, the Southeast, and the Northeast, respectively.…”

Adherence to Positive Airway Pressure Therapy in Patients With Obstructive Sleep Apnea

“…Higher residual apnea-hypopnea index (AHI) (poor efficacy of CPAP delivery) and poor self-efficacy (which involves volition, motivation, and confidence to engage in a healthy behavior) were the significant predictors of “early” nonadherence (during the first two weeks) [ 9 , 10 , 13 ]. On the other hand, long-term nonadherence with CPAP therapy has been associated with the use of CPAP for <4 hours/night during early treatment [ 7 ], moderate to severe OSA [ 11 , 12 , 15 ], lack of a passionate perspective about the benefit of CPAP therapy [ 16 , 17 ], poor self-efficacy [ 7 , 15 - 17 ], and unsupportive bed partner [ 15 ].…”