Determinants of continuous positive airway pressure adherence in a sleep clinic cohort of South Florida Hispanic veterans
- 392 Downloads
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.
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.
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.
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.
KeywordsVeterans Hispanics Continuous positive airway pressure Adherence Obstructive sleep apnea
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.
- 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
- 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.Google Scholar
- 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:A263Google 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 26:727–732PubMedGoogle 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, WestchesterGoogle 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
- 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