Racial disparity in adherence to positive airway pressure among US veterans

Schwartz, Skai W.; Sebastião, Yuri V.; Rosas, Julie; Iannacone, Michelle R.; Foulis, Philip; Anderson, William

doi:10.1007/s11325-016-1316-1

Cited by 19 publications

(16 citation statements)

References 22 publications

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“…20,21,22 Several studies including the current analysis have observed that adherence with PAP is lower among AA patients. 6,23 Lower socioeconomic status and its association with poorer understanding of the risks and consequences of SDB is an important explanation. 7,24 However, cultural differences as well as shorter sleep durations and more insomnia symptoms among AA are likely contributing factors.…”

Section: Discussionmentioning

confidence: 99%

“…3,4 African Americans (AA) also tend to be more obese, have higher rates of hypertension and significantly greater oxygen desaturation during SDB events on polysomnography (PSG); 5 they have been shown to be less adherent to continuous positive airway pressure (CPAP) therapy for SDB. 6 Factors responsible for this disparity in CPAP compliance are unclear, but may partially be explained by lower socioeconomic status 7 and shorter sleep durations. 8 The impact of this sub-optimal CPAP adherence on health outcomes in African Americans is not well understood.…”

Section: Introductionmentioning

confidence: 99%

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Recognition and Treatment of Sleep-disordered Breathing in Obese African American Hospitalized Patients may Improve Outcome

Quintos

Naranjo

Kelly

et al. 2019

Journal of the National Medical Association

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word count : 264 Manuscript word count : 2528 ABSTRACT PURPOSE:The HoSMed Database recently demonstrated a high prevalence of obstructive sleep apnea (OSA) in hospitalized obese patients. Based on a long-term follow-up, this study showed an improved survival among patients who were adherent with the therapy. In this post-hoc analysis we explore the characteristics, associations, and mortality outcome of OSA in the African American (AA) population. METHODS:These subset analyses included obese AA patients screened in the hospital as high-risk for OSA.Stepwise logistic regression analysis was used to identify predictors of OSA. Patients who had polysomnography (PSG) and were initiated on positive airway pressure (PAP) therapy were followed and dichotomized to adherent versus non-adherent groups based on compliance data.Mortality rates in both groups were compared. RESULTS:Of the total of 2022 AA patients screened, 1370 (60.7% females) were identified as high risk for OSA. Of these, 279 had PSG diagnosed OSA (mean AHI = 36 /hour) and were initiated on PAP therapy. Adherence in AAs was significantly lower than for Caucasians (21% versus 45%, Chisquare p<0.0001). The following statistically significant predictors of OSA were found: heart failure, chronic kidney disease, hypertension and asthma/COPD, BMI and age. A Log-rank Recognition and Treatment of Sleep Disordered Breathing in African Americans 3 survival analysis of AAs on CPAP showed non-significant benefit of adherence (HR: 0.22; 95% CI 0.03 -1.7, p=0.11); a propensity analysis of AAs and Caucasians that adjusted for race and potential confounding variables found a statistically significant benefit of adherence (HR: 0.29; 0.13-0.64; p=0.002). CONCLUSION:This large database of hospitalized patients confirms a high prevalence and lower adherence to PAP therapy in African Americans. Adherent patients, however, showed mortality benefit similar to Caucasians.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Recognition and Treatment of Sleep-disordered Breathing in Obese African American Hospitalized Patients may Improve Outcome

Quintos

Naranjo

Kelly

et al. 2019

Journal of the National Medical Association

View full text Add to dashboard Cite

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“…While older age was associated with greater mean daily PAP use among whites, younger age was associated with greater daily PAP use among blacks. In the largest retrospective study examining race-ethnicity and PAP adherence to date [42], Schwartz et al (n=2,172; 233 blacks) found that black veterans were about half as likely as white veterans to use PAP ≥ 4 hrs daily on 70% of day during the initial two weeks (RR 0.58 95% CI: 0.43–0.77) and after six months of therapy (RR 0.52 95% CI 0.36–0.74). These findings were independent of several covariates including age, gender, BMI, OSA severity, oxygen nadir, sleepiness, marital status, and median neighborhood income.…”

Section: Resultsmentioning

confidence: 99%

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

Wallace

Williams

Sawyer

et al. 2018

Sleep Medicine Reviews

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Minority individuals in the United States (US) have an increased prevalence of obstructive sleep apnea (OSA) compared to their white/Caucasian counterparts. In general, adherence to positive airway pressure (PAP) therapy is poor and some studies suggest that PAP use among minority individuals is inferior to that of whites. However, there has not been a review of the evidence that addresses racial-ethnic disparities for PAP adherence in the treatment of OSA, and no review has systematically examined the contributing factors to poor adherence among minority individuals compared to whites. We searched the literature for studies published between January 1990 to July 2016 that included objective PAP use comparisons between adult US minority individuals and whites. Twenty-two studies met the inclusion criteria. All studies compared the PAP adherence of blacks to whites. Seven studies compared the PAP adherence of additional minority groups to that of whites. Sixteen of the 22 studies (73%) showed worse PAP adherence in blacks compared to whites. Four studies found equivalent PAP use in US Hispanics compared to whites. Little is known about the PAP adherence of other US minority groups. We present a framework and research agenda for understanding PAP use barriers among US minority individuals.

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“…Although we compared the MCI +CPAP and the MCI −CPAP groups on 22 potential baseline confounders, and controlled for the differences in our analysis, the groups may have been different on unidentified variables that may have affected the study outcomes. Like others, we found that whites were more likely to adhere to CPAP, and we controlled for race in the data analysis. We also controlled for marital status.…”

Section: Discussionmentioning

confidence: 99%

CPAP Adherence May Slow 1‐Year Cognitive Decline in Older Adults with Mild Cognitive Impairment and Apnea

Richards

Gooneratne

Dicicco

et al. 2019

J American Geriatrics Society

101

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Background/Objectives Obstructive sleep apnea (OSA) has been linked to an increased risk for Alzheimer's disease (AD), but little prospective evidence exists on the effects of OSA treatment in preclinical AD. The objective was to determine if continuous positive airway pressure (CPAP) treatment adherence, controlling for baseline differences, predicts cognitive and everyday function after 1 year in older adults with mild cognitive impairment (MCI) and to determine effect sizes for a larger trial. Design Quasi‐experimental pilot clinical trial with CPAP adherence defined as CPAP use 4 hours or more per night over 1 year. Setting Sleep and geriatric clinics and community. Participants Older adults, aged 55 to 89 years, with an apnea‐hypopnea index of 10 or higher participated: (1) MCI, OSA, and CPAP adherent (MCI +CPAP), n = 29; and (2) MCI, OSA, CPAP nonadherent (MCI −CPAP), n = 25. Intervention CPAP. Measurements The primary cognitive outcome was memory (Hopkins Verbal Learning Test‐Revised), and the secondary cognitive outcome was psychomotor/cognitive processing speed (Digit Symbol subtest from the Wechsler Adult Intelligence Scale Substitution Test). Secondary function and progression measures were the Everyday Cognition, Alzheimer's Disease Cooperative Study‐Clinical Global Impression of Change Scale, and Clinical Dementia Rating. Results Statistically significant improvements in psychomotor/cognitive processing speed in the MCI +CPAP group vs the MCI −CPAP group were observed at 1 year after adjustment for age, race, and marital status (parameter estimate = 1.68; standard error = 0.47; 95% confidence interval = 0.73‐2.62), with a 6‐month effect size (ES) of 0.46 and a 1‐year ES of 1.25. There were small to moderate ESs for memory (ES 0.20, 6 mo), attention (ES 0.25, 1 y), daytime sleepiness (ES 0.33, 6 mo and ES 0.22, 1 y), and everyday function (ES 0.50, 6 mo) favoring the MCI +CPAP group vs the MCI −CPAP group. Conclusion Controlling for baseline differences, 1 year of CPAP adherence in MCI +OSA significantly improved cognition, compared with a nonadherent control group, and may slow the trajectory of cognitive decline. Trial Registration Number Memories; NCT01482351; https://clinicaltrials.gov/ct2/show/NCT01482351?cond=MCI+and+OSA&rank=1 J Am Geriatr Soc 67:558–564, 2019.

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Racial disparity in adherence to positive airway pressure among US veterans

Abstract: CPAP compliance is considerably lower in AAs than in Whites, though severity of OSA modifies this association. These findings are not readily explained by differences in demographics or comorbidity.

Cited by 19 publications

References 22 publications

Recognition and Treatment of Sleep-disordered Breathing in Obese African American Hospitalized Patients may Improve Outcome

Recognition and Treatment of Sleep-disordered Breathing in Obese African American Hospitalized Patients may Improve Outcome

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

CPAP Adherence May Slow 1‐Year Cognitive Decline in Older Adults with Mild Cognitive Impairment and Apnea

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