What are the associations between Black race and positive airway pressure (PAP) therapy adherence among veterans with obstructive sleep apnea (OSA)?
Explore This IssueJanuary 2022
Among veterans with OSA, Black race was associated with reduced PAP adherence, suggesting health inequality among Black individuals in the treatment of OSA.
BACKGROUND: Patient adherence to PAP therapy for individuals with OSA remains poor. Correlating factors to adherence include race, sex, marital status, age, and socioeconomic status. Studies examining the relationship between Black individuals with OSA and PAP adherence have been limited. Prevalence of OSA in certain cohorts of veterans is high.
STUDY DESIGN: Retrospective cohort study.
SETTING: University of California, Los Angeles.
SYNOPSIS: For their large-scale, retrospective study, researchers identified 2,571 patients who were newly diagnosed with OSA at a single Department of Veterans Affairs sleep center between January 2015 and November 2017, and who were newly started on PAP therapy with modem-enabled devices. Researchers used device-transmitted, cloud-based data, along with other demographic and clinical information, to examine the relationship between race and adherence, controlling for sex, marital status, age, socioeconomic status, residual apnea-hypopnea index, and mask leak. Adherence was defined as >4 hours nightly usage for at least 70% of nights from PAP setup. At 30 days, overall adherence was 50%. Black veterans (25%) had reduced 30-day PAP adherence (42% versus 53%) and nightly usage (216 minutes versus 251 minutes). There was no significant difference in adherence with respect to other racial subgroups. Authors note that, as veterans, this cohort had little to no out-of-pocket costs for treatment. Thus, after adjusting for the potential confounder of neighborhood socioeconomic disadvantage, Black race was still associated with a 36% reduction in PAP adherence. Study limitations included the retrospective design, which did not allow researchers to determine the basis for the relationship between Black race and lower adherence.
CITATION: Hsu N, Zeidler MR, Ryden AM, et al. Racial disparities in positive airway pressure therapy adherence among veterans with obstructive sleep apnea. J Clin Sleep Med. 2020;16:1249-1254.