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Sleep and Breathing
Published in: Sleep and Breathing 1/2013

01-03-2013 | Original Article

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

Authors: D. M. Wallace, S. S. Vargas, S. J. Schwartz, M. S. Aloia, S. Shafazand

Published in: Sleep and Breathing | Issue 1/2013

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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.
Literature
1.
2.
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 26:367–397PubMedCrossRef
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 18:73–82PubMed
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 21:91–96PubMedCrossRef
6.
Loredo JS, Soler X, Bardwell W, Ancoli-Israel S, Dimsdale JE, Palinkas LA (2010) Sleep health in U.S. Hispanic population. Sleep 33:962–967PubMed
7.
Pawson IG, Martorell R, Mendoza FE (1991) Prevalence of overweight and obesity in US Hispanic populations. Am J Clin Nutr 53:1522S–1528SPubMed
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 4:236–243PubMedCrossRef
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 89:723–730PubMedCrossRef
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 10:70–75PubMedCrossRef
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 13:175–180PubMedCrossRef
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
14.
Gay P, Weaver T, Loube D, Iber C (2006) Evaluation of positive airway pressure treatment for sleep related breathing disorders in adults. Sleep 29:381–401PubMed
15.
Engleman HM, Wild MR (2003) Improving CPAP use by patients with the sleep apnoea/hypopnoea syndrome (SAHS). Sleep Med Rev 7:81–99PubMedCrossRef
16.
Shapiro GK, Shapiro CM (2010) Factors that influence CPAP adherence: an overview. Sleep Breath 14:323–335PubMedCrossRef
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 15:343–356PubMedCrossRef
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 8:260–273PubMedCrossRef
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 108:812–821PubMedCrossRef
20.
Abrishami A, Khajehdehi A, Chung F (2010) A systematic review of screening questionnaires for obstructive sleep apnea. Can J Anaesth 57:423–438PubMedCrossRef
21.
Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14:540–545PubMed
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 9:5–11PubMedCrossRef
23.
Bastien CH, Vallieres A, Morin CM (2001) Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Med 2:297–307PubMedCrossRef
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 28:193–213PubMedCrossRef
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 53:737–740PubMedCrossRef
26.
Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67:361–370PubMedCrossRef
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 21:22–31PubMedCrossRef
28.
Schwartz SJ, Zamboanga BL (2008) Testing Berry's model of acculturation: a confirmatory latent class approach. Cultur Divers Ethnic Minor Psychol 14:275–285PubMedCrossRef
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 33:157–174PubMedCrossRef
30.
Digman JM (1989) Five robust trait dimensions: development, stability, and utility. J Pers 57:195–214PubMedCrossRef
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 15:687–694PubMedCrossRef
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 26:727–732PubMed
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 34:1595–1603PubMed
34.
Sawyer AM, Canamucio A, Moriarty H, Weaver TE, Richards KC, Kuna ST (2011) Do cognitive perceptions influence CPAP use? Patient Educ Couns 85:85–91PubMedCrossRef
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 20:835–843PubMed
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
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 5:229–240PubMedCrossRef
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 32:799–806PubMed
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 30:320–324PubMed
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 23:654–671PubMedCrossRef
41.
Vega WA, Rodriguez MA, Gruskin E (2009) Health disparities in the Latino population. Epidemiol Rev 31:99–112PubMedCrossRef
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 8:180–187CrossRef
43.
Blondet MC, Perez J, Rodriguez W (2001) Continuous positive airway pressure and obstructive sleep apnea in an Hispanic population. Sleep Breath 5:109–114PubMedCrossRef
44.
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 15:711–715PubMedCrossRef
46.
Sharafkhaneh A, Giray N, Richardson P, Young T, Hirshkowitz M (2005) Association of psychiatric disorders and sleep apnea in a large cohort. Sleep 28:1405–1411PubMed
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 27:134–138PubMed
48.
Wickwire EM, Smith MT, Birnbaum S, Collop NA (2010) Sleep maintenance insomnia complaints predict poor CPAP adherence: a clinical case series. Sleep Med 11:772–776PubMedCrossRef
49.
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 1:346–353PubMed
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 20:278–283PubMed
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 159:1108–1114PubMed
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 2:225–232PubMedCrossRef
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 121:430–435PubMedCrossRef
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 15:599–606PubMedCrossRef
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 159:1096–1100PubMed
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 15:525–534PubMedCrossRef
58.
Safeer RS, Keenan J (2005) Health literacy: the gap between physicians and patients. Am Fam Physician 72:463–468PubMed
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 37:69–76PubMedCrossRef
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 138:257–263PubMedCrossRef
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 32:545–552PubMed
Metadata
Title
Determinants of continuous positive airway pressure adherence in a sleep clinic cohort of South Florida Hispanic veterans
Authors
D. M. Wallace
S. S. Vargas
S. J. Schwartz
M. S. Aloia
S. Shafazand
Publication date
01-03-2013
Publisher
Springer-Verlag
Published in
Sleep and Breathing / Issue 1/2013
Print ISSN: 1520-9512
Electronic ISSN: 1522-1709
DOI
https://doi.org/10.1007/s11325-012-0702-6

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