Abstract
Studies of continuous positive airway pressure (CPAP) adherence in multi-ethnic samples are lacking. This study explores previously described factors associated with therapeutic CPAP use in South Florida veterans with obstructive sleep apnea-hypopnea syndrome (OSAHS). We performed a retrospective, cross-sectional analysis of CPAP adherence comparing white, black, and Hispanic veterans returning to the Miami VA sleep clinic over a 4-month period. Participants had CPAP use download and completed questionnaires on demographics, sleepiness, insomnia, and social cognitive measures related to adherence. Linear regression modeling was used to explore the impact of measured variables and potential interactions with race-ethnicity on mean daily CPAP use. Participants (N = 248) were 94% male with mean age of 59 ± 11 years and included 95 blacks (38%), 91 whites (37%), and 62 Hispanic (25%) veterans. Blacks had less mean daily CPAP use than whites (-1.6 h, p < 0.001) and Hispanics (-1.3 h, p < 0.01). Blacks reported worse sleep onset insomnia symptoms compared to whites. In the final multivariable regression model, black race-ethnicity (p < 0.01), insomnia symptoms (p < 0.001), and self-efficacy (p < 0.001) were significantly associated with mean daily CPAP use. In addition, the black race by age interaction term showed a trend towards significance (p = 0.10). In agreement with recent studies, we found that mean daily CPAP use in blacks was 1 hour less than whites after adjusting for covariates. No CPAP adherence differences were noted between whites and Hispanics. Further investigations exploring sociocultural barriers to regular CPAP use in minority individuals with OSAHS are needed.
Highlights
The Association of Age, Insomnia, and Self-Efficacy with Continuous Positive Airway Pressure Adherence in Black, White, and Hispanic US Veterans
Our study aims were (1) to examine previously established variables associated with continuous positive airway pressure (CPAP) adherence in a culturally diverse sample, and (2) to explore race-ethnic variation in these established factors associated with regular CPAP use in South Florida veterans with obstructive sleep apnea-hypopnea syndrome (OSAHS)
Our goals were two-fold: (1) to examine previously described variables associated with CPAP adherence in a culturally diverse OSAHS sample of American veterans in a sleep clinic sample, and (2) to determine if race-ethnicity moderated predictors of CPAP adherence in South Florida veterans with OSAHS
Summary
The Association of Age, Insomnia, and Self-Efficacy with Continuous Positive Airway Pressure Adherence in Black, White, and Hispanic US Veterans. The association of age, insomnia, and self-efficacy with continuous positive airway pressure adherence in black, white, and Hispanic US veterans. O bstructive sleep apnea-hypopnea syndrome (OSAHS) may affect up to 2% of women and 4% of men in the US population.[1] It is associated with lower quality of life, greater healthcare utilization, neurobehavioral deficits, and increased risk of hypertension, cardiovascular events, and all-cause mortality.[1,2,3,4] Continuous positive airway pressure (CPAP), the first-line treatment for moderate to severe OSAHS, completely or partially reverses many of these deleterious consequences when used consistently.[5] despite its efficacy, empirical studies suggest that rates for regular CPAP use (≥ 4 h daily) range from 30% to 60%.6. This study describes the influence of demographics, disease severity, sleepiness, insomnia, social cognitive measures, and the interaction of race-ethnicity with these variables on CPAP adherence in a South Florida veteran sleep clinic sample. We found an interaction of black race with age and CPAP adherence, suggesting that generational effects may be considered when developing programs to enhance CPAP adherence in blacks
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