Abstract P313: Self-reported Sleep Disturbance is Associated With Poor Hypertension Self-management in Latinos

Abstract

Background: Antihypertensive medication adherence is an important determinant of hypertension control. Although Latinos have high rates of uncontrolled hypertension, factors associated with anti-hypertensive medication adherence in this population are poorly understood. Self-reported sleep disturbance is associated with impaired chronic disease self-management in the general population. To date, no study has examined the association of sleep disturbance with hypertension self-management among Latinos. Hypothesis: Sleep disturbances will be associated with poor anti-hypertensive medication adherence and higher rates of uncontrolled hypertension in Latinos. Methods: We used cross-sectional data from the Washington Heights/Inwood Comparative Effectiveness Research (WICER) Project to assess the link between sleep disturbance with anti-hypertensive medication adherence and uncontrolled hypertension among Latinos with hypertension. The 8-item Morisky Medication Adherence Scale (MMAS) was used to assess medication adherence (alpha 0.75; range 0-8). The 4-item Patient-Reported Outcomes Measurement Information System (PROMIS) sleep disturbance measure was used (alpha 0.75; range 4-20). Uncontrolled hypertension was defined as a systolic blood pressure ≥130 mm Hg and/or diastolic blood pressure ≥80 mm Hg. Multiple logistic regression models were used to examine the associations of self-reported sleep disturbance with low medication adherence (MMAS <6). In addition, we examined whether sleep disturbance was associated with uncontrolled hypertension. Models were adjusted for age, sex, education, preferred language, insurance status, comorbid conditions, and anxiety. Results: The final sample consisted of 1,116 Latino participants with hypertension (mean age 63.2, 76.8% were female, and 69.5% had completed less than a high school education). The mean MMAS and PROMIS sleep disturbance scores were 1.9 and 10.1, respectively. A total of 341 (30.4%) participants were classified as having low medication adherence. Participants with low medication adherence were more likely to be younger (p <0.001), single (p <0.001), and have lower educational attainment (p <0.01). After covariate adjustment, a one-point increase in sleep disturbance was associated with higher odds of low medication adherence (AOR 1.05, 95% CI [1.01-1.09]). Sleep disturbance was also associated with higher odds of uncontrolled hypertension (AOR 1.04, 95% CI [1.01-1.07]). Conclusions: Reducing sleep disturbance in Latinos may be an important target for improving hypertension self-management. It remains unclear whether sleep disturbances are a cause of poor hypertension self-management in these patients. Additional research that incorporates longitudinal designs is needed to examine associations between sleep disturbance and hypertension self-management among Latinos.