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Racial disparity in adherence to positive airway pressure among US veterans

  • Sleep Breathing Physiology and Disorders • Original Article
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Abstract

Purpose

Despite advances in continuous positive airway pressure (CPAP) technology, compliance with CPAP therapy remains suboptimal. Studies conducted since the advent of objective CPAP recording have noted that African Americans (AA) may use CPAP less than Whites. We sought to confirm this finding among a large sample of veterans and examine effect modifiers of the differential usage.

Methods

A retrospective cohort of 233 AA and 1939 White Veterans Administration (VA) patients who had a sleep study between January 2003 and October 2006 and received CPAP therapy by the end of 2007. CPAP compliance was summarized at 2 weeks and 6 months post CPAP receipt.

Results

AAs were significantly less adherent than Whites even when controlling for age, gender, marital status, median household income for zip code, BMI, comorbidities, and obstructive sleep apnea (OSA) severity. AAs with severe OSA were 3 times more likely to use CPAP than AAs with mild/moderate OSA (p ≤ 0.001); a much smaller but still statistically significant difference was seen for Whites.

Conclusions

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.

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Acknowledgments

The authors gratefully acknowledge JAHVA for its support of this research. The views expressed here do not necessarily reflect the views of the Veterans Administration. This material is the result of work supported with resources and the use of facilities at the James A. Haley Veterans Hospital, Tampa Florida, Office of Health Services Research and Development Service, and Rehabilitation Research and Development. The authors also gratefully acknowledge the editorial assistance provided by Debra Weiner.

Author information

Authors and Affiliations

  1. Department of Epidemiology and Biostatistics, College of Public Health MDC-56, University of South Florida, Tampa, FL, 33612, USA

    Skai W. Schwartz, Yuri Sebastião & Michelle R. Iannacone

  2. Medical Service, James A. Haley VA Hospital, Tampa, FL, USA

    Julie Rosas & W. McDowell Anderson

  3. Laboratory Service, James A. Haley VA Hospital, Tampa, FL, USA

    Philip R. Foulis

  4. Department of Pathology and Cell Biology, University of South Florida, Tampa, FL, USA

    Philip R. Foulis

  5. Division of Pulmonary, Critical Care and Sleep Medicine, University of South Florida, Tampa, FL, USA

    W. McDowell Anderson

Authors
  1. Skai W. Schwartz
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  2. Yuri Sebastião
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  3. Julie Rosas
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  4. Michelle R. Iannacone
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  5. Philip R. Foulis
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  6. W. McDowell Anderson
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Corresponding author

Correspondence to Skai W. Schwartz.

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Funding

No funding was received for this research.

Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

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Schwartz, S.W., Sebastião, Y., Rosas, J. et al. Racial disparity in adherence to positive airway pressure among US veterans. Sleep Breath 20, 947–955 (2016). https://doi.org/10.1007/s11325-016-1316-1

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  • DOI: https://doi.org/10.1007/s11325-016-1316-1

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