Skip to main content

Advertisement

SpringerLink
Log in

Determinants of continuous positive airway pressure adherence in a sleep clinic cohort of South Florida Hispanic veterans

  • Original Article
  • Published:
Sleep and Breathing Aims and scope Submit manuscript

Abstract

Purpose

There are little existing data on continuous positive airway pressure (CPAP) adherence in US Hispanic veterans with obstructive sleep apnea (OSA). Our aim was to describe determinants of 1-month adherence in a sleep clinic cohort of South Florida Hispanic veterans.

Methods

Hispanic veterans referred to the Miami VA sleep clinic were recruited and completed questionnaires about sleep apnea risk, sleep quality, insomnia symptoms, sleepiness, depression/anxiety, acculturation, personality traits, and cognitions about OSA and CPAP. Individuals at risk for OSA were scheduled for baseline polysomnography (PSG), followed by in-lab CPAP titration or a trial of auto-CPAP. Participants with OSA accepting CPAP therapy were asked to return after 7 and 30 days of treatment for adherence verification and to repeat questionnaires.

Results

One hundred twenty-four participants (94 % men) were enrolled with 114 completing overnight PSG. Eighty-six out of 95 participants (91 %) with sleep apnea syndrome or moderate to severe OSA accepted CPAP treatment. Fifty-nine participants completed both follow-up visits with a mean CPAP use at 30 days of 3.6 ± 2.0 h. The only independent predictor of 7-day mean daily CPAP use was the baseline Insomnia Severity Index while the best predictor of 30-day mean daily CPAP use was the 7-day mean daily use.

Conclusions

Our study suggests that South Florida Hispanic veterans with OSA evaluated in a sleep clinic show poor CPAP adherence. Insomnia and poor early use predicted poor adherence overall. Larger prospective studies with other race–ethnic groups are needed to determine the role of ethnicity and race in CPAP adherence among US veterans with OSA.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. 2010 Census Data. http://2010.census.gov/2010census/data. Accessed 26 Jun 2011

  2. National Center for Veteran Analysis and Statistics. United States Department of Veterans Affairs Veteran Population Projections: FY2000 to FY2036. http://www.va.gov/vetdata/docs/quickfacts/Population-slideshow.pdf. Accessed 19 Sep 2011

  3. Lara M, Gamboa C, Kahramanian MI, Morales LS, Bautista DE (2005) Acculturation and Latino health in the United States: a review of the literature and its sociopolitical context. Annu Rev Public Health 26:367–397

    Article  PubMed  Google Scholar 

  4. Otero-Sabogal R, Sabogal F, Perez-Stable EJ, Hiatt RA (1995) Dietary practices, alcohol consumption, and smoking behavior: ethnic, sex, and acculturation differences. J Natl Cancer Inst Monogr 18:73–82

    PubMed  Google Scholar 

  5. Khan LK, Sobal J, Martorell R (1997) Acculturation, socioeconomic status, and obesity in Mexican Americans, Cuban Americans, and Puerto Ricans. Int J Obes Relat Metab Disord 21:91–96

    Article  PubMed  CAS  Google Scholar 

  6. Loredo JS, Soler X, Bardwell W, Ancoli-Israel S, Dimsdale JE, Palinkas LA (2010) Sleep health in U.S. Hispanic population. Sleep 33:962–967

    PubMed  Google Scholar 

  7. Pawson IG, Martorell R, Mendoza FE (1991) Prevalence of overweight and obesity in US Hispanic populations. Am J Clin Nutr 53:1522S–1528S

    PubMed  CAS  Google Scholar 

  8. Teppala S, Shankar A, Ducatman A (2010) The association between acculturation and hypertension in a multiethnic sample of US adults. J Am Soc Hypertens 4:236–243

    Article  PubMed  Google Scholar 

  9. Sundquist J, Winkleby MA (1999) Cardiovascular risk factors in Mexican American adults: a transcultural analysis of NHANES III, 1988–1994. Am J Public Health 89:723–730

    Article  PubMed  CAS  Google Scholar 

  10. Ocasio-Tascon ME, Alicea-Colon E, Torres-Palacios A, Rodriguez-Cintron W (2006) The veteran population: one at high risk for sleep-disordered breathing. Sleep Breath 10:70–75

    Article  PubMed  Google Scholar 

  11. Blondet M, Yapor P, Latalladi-Ortega G, Alicea E, Torres-Palacios A, Rodriguez-Cintron W (2009) Prevalence and risk factors for sleep disordered breathing in a Puerto Rican middle-aged population. Sleep Breath 13:175–180

    Article  PubMed  Google Scholar 

  12. Redline S AR, Daviglus ML, Hall M, Levine D, Loredo JS, Patel SR, Ries AL, Sotres-Alvarez D, Twery M, Youngblood M, Zee P (2011) Prevalence of sleep apnea, associated symptoms and co-morbidities in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Nutrition, Physical Activity and Metabolism and Cardiovascular Disease Epidemiology and Prevention Joint Conference; Atlanta, GA.

  13. Shafazand S, Wallace DM, Vargas S, Quevedo H, Fleming L (2011) Sleep quality, sleep disordered breathing, and insomnia in US Hispanic patients. Sleep 34:A263

    Google Scholar 

  14. Gay P, Weaver T, Loube D, Iber C (2006) Evaluation of positive airway pressure treatment for sleep related breathing disorders in adults. Sleep 29:381–401

    PubMed  Google Scholar 

  15. Engleman HM, Wild MR (2003) Improving CPAP use by patients with the sleep apnoea/hypopnoea syndrome (SAHS). Sleep Med Rev 7:81–99

    Article  PubMed  Google Scholar 

  16. Shapiro GK, Shapiro CM (2010) Factors that influence CPAP adherence: an overview. Sleep Breath 14:323–335

    Article  PubMed  Google Scholar 

  17. Sawyer AM, Gooneratne NS, Marcus CL, Ofer D, Richards KC, Weaver TE (2011) A systematic review of CPAP adherence across age groups: clinical and empiric insights for developing CPAP adherence interventions. Sleep Med Rev 15:343–356

    Article  PubMed  Google Scholar 

  18. Means MK, Ulmer CS, Edinger JD (2010) Ethnic differences in continuous positive airway pressure (CPAP) adherence in veterans with and without psychiatric disorders. Behav Sleep Med 8:260–273

    Article  PubMed  Google Scholar 

  19. Chung F, Yegneswaran B, Liao P, Chung SA, Vairavanathan S, Islam S, Khajehdehi A, Shapiro CM (2008) STOP questionnaire: a tool to screen patients for obstructive sleep apnea. Anesthesiology 108:812–821

    Article  PubMed  Google Scholar 

  20. Abrishami A, Khajehdehi A, Chung F (2010) A systematic review of screening questionnaires for obstructive sleep apnea. Can J Anaesth 57:423–438

    Article  PubMed  Google Scholar 

  21. Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14:540–545

    PubMed  CAS  Google Scholar 

  22. Johns MW (2000) Sensitivity and specificity of the multiple sleep latency test (MSLT), the maintenance of wakefulness test and the Epworth sleepiness scale: failure of the MSLT as a gold standard. J Sleep Res 9:5–11

    Article  PubMed  CAS  Google Scholar 

  23. Bastien CH, Vallieres A, Morin CM (2001) Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Med 2:297–307

    Article  PubMed  Google Scholar 

  24. Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ (1989) The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 28:193–213

    Article  PubMed  CAS  Google Scholar 

  25. Backhaus J, Junghanns K, Broocks A, Riemann D, Hohagen F (2002) Test–retest reliability and validity of the Pittsburgh Sleep Quality Index in primary insomnia. J Psychosom Res 53:737–740

    Article  PubMed  Google Scholar 

  26. Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67:361–370

    Article  PubMed  CAS  Google Scholar 

  27. Guo X, Suarez-Morales L, Schwartz SJ, Szapocznik J (2009) Some evidence for multidimensional biculturalism: confirmatory factor analysis and measurement invariance analysis on the Bicultural Involvement Questionnaire-Short Version. Psychol Assess 21:22–31

    Article  PubMed  Google Scholar 

  28. Schwartz SJ, Zamboanga BL (2008) Testing Berry's model of acculturation: a confirmatory latent class approach. Cultur Divers Ethnic Minor Psychol 14:275–285

    Article  PubMed  Google Scholar 

  29. Coatsworth JD, Maldonado-Molina M, Pantin H, Szapocznik J (2005) A person-centered and ecological investigation of acculturation strategies in Hispanic immigrant youth. J Community Psychol 33:157–174

    Article  PubMed  Google Scholar 

  30. Digman JM (1989) Five robust trait dimensions: development, stability, and utility. J Pers 57:195–214

    Article  PubMed  CAS  Google Scholar 

  31. Moran AM, Everhart DE, Davis CE, Wuensch KL, Lee DO, Demaree HA (2010) Personality correlates of adherence with continuous positive airway pressure (CPAP). Sleep Breath 15:687–694

    Article  PubMed  Google Scholar 

  32. Weaver TE, Maislin G, Dinges DF, Younger J, Cantor C, McCloskey S, Pack AI (2003) Self-efficacy in sleep apnea: instrument development and patient perceptions of obstructive sleep apnea risk, treatment benefit, and volition to use continuous positive airway pressure. Sleep 26:727–732

    PubMed  Google Scholar 

  33. Bakker JP, O'Keefe KM, Neill A, Campbell A (2011) Ethnic disparities in CPAP compliance in New Zealand: effects of socioeconomic deprivation, health literacy and self-efficacy. Sleep 34:1595–1603

    PubMed  Google Scholar 

  34. Sawyer AM, Canamucio A, Moriarty H, Weaver TE, Richards KC, Kuna ST (2011) Do cognitive perceptions influence CPAP use? Patient Educ Couns 85:85–91

    Article  PubMed  Google Scholar 

  35. Weaver TE, Laizner AM, Evans LK, Maislin G, Chugh DK, Lyon K, Smith PL, Schwartz AR, Redline S, Pack AI, Dinges DF (1997) An instrument to measure functional status outcomes for disorders of excessive sleepiness. Sleep 20:835–843

    PubMed  CAS  Google Scholar 

  36. Iber C, Ancoli-Israel S, Chesson A, Quan SF for the American academy of sleep medicine (2007) The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications, 1st edn. American Academy of Sleep Medicine, Westchester

    Google Scholar 

  37. Aloia MS, Arnedt JT, Stanchina M, Millman RP (2007) How early in treatment is PAP adherence established? Revisiting night-to-night variability. Behav Sleep Med 5:229–240

    Article  PubMed  Google Scholar 

  38. Platt AB, Field SH, Asch DA, Chen Z, Patel NP, Gupta R, Roche DF, Gurubhagavatula I, Christie JD, Kuna ST (2009) Neighborhood of residence is associated with daily adherence to CPAP therapy. Sleep 32:799–806

    PubMed  Google Scholar 

  39. Budhiraja R, Parthasarathy S, Drake CL, Roth T, Sharief I, Budhiraja P, Saunders V, Hudgel DW (2007) Early CPAP use identifies subsequent adherence to CPAP therapy. Sleep 30:320–324

    PubMed  Google Scholar 

  40. Saha S, Freeman M, Toure J, Tippens KM, Weeks C, Ibrahim S (2008) Racial and ethnic disparities in the VA health care system: a systematic review. J Gen Intern Med 23:654–671

    Article  PubMed  Google Scholar 

  41. Vega WA, Rodriguez MA, Gruskin E (2009) Health disparities in the Latino population. Epidemiol Rev 31:99–112

    Article  PubMed  Google Scholar 

  42. Baldwin CM, Reynaga-Ornelas L, Caudillo-Cisneros C, Marquez-Gamino S, Quan SF (2010) Overview of sleep disorders among Latinos in the United States. Hispanic Health Care Int 8:180–187

    Article  Google Scholar 

  43. Blondet MC, Perez J, Rodriguez W (2001) Continuous positive airway pressure and obstructive sleep apnea in an Hispanic population. Sleep Breath 5:109–114

    Article  PubMed  CAS  Google Scholar 

  44. Al-Jawder SE, Bahammam AS (2012) Comorbid insomnia in sleep-related breathing disorders: an under-recognized association. Sleep Breath 16(2):295–304. doi:10.1007/s11325-011-0513-1

    Article  PubMed  Google Scholar 

  45. Subramanian S, Guntupalli B, Murugan T, Bopparaju S, Chanamolu S, Casturi L, Surani S (2011) Gender and ethnic differences in prevalence of self-reported insomnia among patients with obstructive sleep apnea. Sleep Breath 15:711–715

    Article  PubMed  Google Scholar 

  46. Sharafkhaneh A, Giray N, Richardson P, Young T, Hirshkowitz M (2005) Association of psychiatric disorders and sleep apnea in a large cohort. Sleep 28:1405–1411

    PubMed  Google Scholar 

  47. Lewis KE, Seale L, Bartle IE, Watkins AJ, Ebden P (2004) Early predictors of CPAP use for the treatment of obstructive sleep apnea. Sleep 27:134–138

    PubMed  Google Scholar 

  48. Wickwire EM, Smith MT, Birnbaum S, Collop NA (2010) Sleep maintenance insomnia complaints predict poor CPAP adherence: a clinical case series. Sleep Med 11:772–776

    Article  PubMed  Google Scholar 

  49. Pieh C, Bach M, Popp R, Jara C, Cronlein T, Hajak G, Geisler P (2012) Insomnia symptoms influence CPAP compliance. Sleep Breath. doi:10.1007/s11325-012-0655-9

  50. Aloia MS, Arnedt JT, Stepnowsky C, Hecht J, Borrelli B (2005) Predicting treatment adherence in obstructive sleep apnea using principles of behavior change. J Clin Sleep Med 1:346–353

    PubMed  Google Scholar 

  51. Weaver TE, Kribbs NB, Pack AI, Kline LR, Chugh DK, Maislin G, Smith PL, Schwartz AR, Schubert NM, Gillen KA, Dinges DF (1997) Night-to-night variability in CPAP use over the first three months of treatment. Sleep 20:278–283

    PubMed  CAS  Google Scholar 

  52. McArdle N, Devereux G, Heidarnejad H, Engleman HM, Mackay TW, Douglas NJ (1999) Long-term use of CPAP therapy for sleep apnea/hypopnea syndrome. Am J Respir Crit Care Med 159:1108–1114

    PubMed  CAS  Google Scholar 

  53. Pelletier-Fleury N, Rakotonanahary D, Fleury B (2001) The age and other factors in the evaluation of compliance with nasal continuous positive airway pressure for obstructive sleep apnea syndrome. A Cox’s proportional hazard analysis. Sleep Med 2:225–232

    Article  PubMed  Google Scholar 

  54. Sin DD, Mayers I, Man GC, Pawluk L (2002) Long-term compliance rates to continuous positive airway pressure in obstructive sleep apnea: a population-based study. Chest 121:430–435

    Article  PubMed  Google Scholar 

  55. Baron KG, Berg CA, Czajkowski LA, Smith TW, Gunn HE, Jones CR (2011) Self-efficacy contributes to individual differences in subjective improvements using CPAP. Sleep Breath 15:599–606

    Article  PubMed  Google Scholar 

  56. Hoy CJ, Vennelle M, Kingshott RN, Engleman HM, Douglas NJ (1999) Can intensive support improve continuous positive airway pressure use in patients with the sleep apnea/hypopnea syndrome? Am J Respir Crit Care Med 159:1096–1100

    PubMed  CAS  Google Scholar 

  57. Baron KG, Smith TW, Berg CA, Czajkowski LA, Gunn H, Jones CR (2011) Spousal involvement in CPAP adherence among patients with obstructive sleep apnea. Sleep Breath 15:525–534

    Article  PubMed  Google Scholar 

  58. Safeer RS, Keenan J (2005) Health literacy: the gap between physicians and patients. Am Fam Physician 72:463–468

    PubMed  Google Scholar 

  59. Zonato AI, Bittencourt LR, Martinho FL, Baiard P, Togeiro SM, Benedito-Silva AA, Tufik S (2004) A comparison of public and private obstructive sleep apnea clinics. Braz J Med Biol Res 37:69–76

    Article  PubMed  CAS  Google Scholar 

  60. Xu T, Li T, Wei D, Feng Y, Xian L, Wu H, Xu J (2012) Effect of automatic versus fixed continuous positive airway pressure for the treatment of obstructive sleep apnea: an up-to-date meta-analysis. Sleep Breath. doi:1007/s11325-011-0626-6

  61. Skomro RP, Gjevre J, Reid J, McNab B, Ghosh S, Stiles M, Jokic R, Ward H, Cotton D (2010) Outcomes of home-based diagnosis and treatment of obstructive sleep apnea. Chest 138:257–263

    Article  PubMed  Google Scholar 

  62. Simon-Tuval T, Reuveni H, Greenberg-Dotan S, Oksenberg A, Tal A, Tarasiuk A (2009) Low socioeconomic status is a risk factor for CPAP acceptance among adult OSAS patients requiring treatment. Sleep 32:545–552

    PubMed  Google Scholar 

Download references

Acknowledgments

This material is based upon work performed at the Miami VA Healthcare System. Dr. Shafazand was supported by a grant from the American Sleep Medicine Foundation.

Conflict of interest

The authors have no conflicts of interests regarding the project described herein.

Author information

Authors and Affiliations

  1. Department of Neurology, Sleep Medicine Division, University of Miami Miller School of Medicine, Miami, FL, USA

    D. M. Wallace

  2. Bruce W. Carter Department of Veterans Affairs Medical Center, Neurology Service, 1201 NW 16th Street, Miami, FL, 33125, USA

    D. M. Wallace

  3. Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Miami Miller School of Medicine, Miami, FL, USA

    S. S. Vargas & S. Shafazand

  4. Center for Family Studies, University of Miami Miller School of Medicine, Miami, FL, USA

    S. J. Schwartz

  5. Department of Medicine, National Jewish Health, Denver, CO, USA

    M. S. Aloia

Authors
  1. D. M. Wallace
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. S. Vargas
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. J. Schwartz
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. S. Aloia
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. S. Shafazand
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to D. M. Wallace.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wallace, D.M., Vargas, S.S., Schwartz, S.J. et al. Determinants of continuous positive airway pressure adherence in a sleep clinic cohort of South Florida Hispanic veterans. Sleep Breath 17, 351–363 (2013). https://doi.org/10.1007/s11325-012-0702-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11325-012-0702-6

Keywords

Search

Navigation