Ethnic Disparities in CPAP Adherence in New Zealand: Effects of Socioeconomic Status, Health Literacy and Self-Efficacy

Bakker, Jessie P.; O'Keeffe, Karyn; Neill, Alister; Campbell, Angela

doi:10.5665/sleep.1404

Cited by 83 publications

(93 citation statements)

References 38 publications

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“…Other studies examining for multiple predictors of CPAP adherence have also found low explanatory power (4% to 25%). 18,36,[40][41][42] Few reliable determinants of CPAP adherence have been established, with polysomnographic severity and higher levels of baseline sleepiness (ESS score) the most consistent baseline correlate of ongoing CPAP use. 37,43,44 Studies have mostly used univariate analyses, finding only weak to moderate correlations with these findings likely to vary with sample size, statistical power, and selection bias in clinical samples.…”

Section: Discussionmentioning

confidence: 99%

Depression May Reduce Adherence during CPAP Titration Trial

Law

Naughton

et al. 2014

Journal of Clinical Sleep Medicine

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Study Objectives: Depression is a risk factor for medication non-compliance. We aimed to identify if depression is associated with poorer adherence during home-based autotitrating continuous positive airway pressure (autoPAP) titration. Design: Mixed retrospective-observational study. Setting: Academic center. Participants: Two-hundred forty continuous positive airway pressure-naïve obstructive sleep apnea (OSA) patients. Measurements:Patients underwent approximately 1 week of home-based autoPAP titration with adherence data downloaded from the device. Electronic hospital records were reviewed in a consecutive manner for inclusion. Three areas of potential predictors were examined: (i) demographics and clinical factors, (ii) disease severity, and (iii) device-related variables. Depression and anxiety were assessed using the Hospital Anxiety and Depression Scale (HADS). Scores on the subscales were categorized as normal or clinical diagnoses of depression (≥ 8) and anxiety (≥ 11). The primary outcome variable was the mean hours of autoPAP used per night. th percentile pressure and autoPAP use. Conclusion: Depression was independently associated with poorer adherence during home-based autoPAP titration. Depression may be a potential target for clinicians and future research aimed at enhancing adherence to autoPAP therapy.

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Section: Discussionmentioning

confidence: 99%

Depression May Reduce Adherence during CPAP Titration Trial

Law

Naughton

et al. 2014

Journal of Clinical Sleep Medicine

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“…42,45,53 Similarly, psychological factors have also been shown to predict adherence in many studies, [18][19][20] although not in all. 47,49 Most of the current literature focuses on the use of psychological interventions to promote CPAP usage (CBT, 54 motivational interviewing 55 ), but these are time and resource intensive, so that identifying who would or would not benefit from these interventions may be useful. Our data focus on the earliest possible identification of these subjects using measurements routinely collected in a sleep laboratory for clinical purposes (e.g., the CPAP titration NPSG).…”

Section: 49mentioning

confidence: 99%

Sleep Quality, Short-Term and Long-Term CPAP Adherence

Somiah

Taxin

Keating

et al. 2012

Journal of Clinical Sleep Medicine

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S C I E N T I F I C I N V E S T I G A T I O N SU ntreated obstructive sleep apnea/hypopnea syndrome (OSAHS) signifi cantly affects quality of life and cardiovascular/cerebrovascular morbidities and mortality.1-4 CPAP therapy has been shown to be effective in treating sleep disordered breathing (SDB) by reducing the apnea/hypopnea index (AHI) 5 and by reducing excessive daytime somnolence (EDS). 6Despite this, CPAP acceptance and adherence are disappointingly low. A signifi cant number of patients (ranging from 30% to 80% in various studies) demonstrate an average CPAP usage of less than 4 hours per night. 7,8 Several reviews have emphasized the need to identify patients who are at the greatest risk for non-adherence, with the goal of developing techniques to maximize overall adherence. 9,10Studies have suggested that CPAP adherence can be correlated to characteristics of patients at baseline, such as the severity of OSAHS, 11-13 the level of EDS, 14 and anatomical factors (smaller nasal cross-sectional area, reduced nasal volume, and high nasal resistance 15,16 ), but the strength of these correlations has been weak. Drake et al. showed that patients whose sleep effi ciency on the CPAP titration night improved most had the greatest CPAP compliance at 47 days.17 More recently, studies using social cognitive theory 18-20 and health BRIEF SUMMARYCurrent knowledge/Study Rationale: Despite its efficacy, adherence to CPAP therapy is highly variable amongst patients with obstructive sleep apnea with large numbers of patients demonstrating inadequate adherence to CPAP. The present study is aimed at identifying early predictors of CPAP adherence from variables obtained at the time of diagnosis and titration of CPAP, thereby providing potential for early intervention. Study Impact: Our data show that better sleep quality (greater % REM) was seen in patients with higher CPAP adherence and confi rm that long term adherence was largely predicted by short term adherence. This suggests that interventions that improve sleep during or prior to the CPAP titration study may be useful in improving CPAP adherence.

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“…22,23 Other vulnerable groups have also been found to have lower CPAP adherence. 24 Little information is available regarding the success of specific OSA treatment options in South Asians. While the heterogeneous results of CPAP studies on metabolic syndrome may be due to differences in study design, [25][26][27] another possible explanation is that the metabolic impact of OSA therapy in South Asians may differ from whites.…”

Section: Sleep Apnea and Cardiometabolic Risk In South Asiansmentioning

confidence: 99%