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Neighborhood of residence is associated with daily adherence to CPAP therapy.

Authors
Platt-AB; Field-SH; Asch-DA; Chen-Z; Patel-NP; Gupta-R; Roche-DF; Gurubhagavatula-I; Christie-JD; Kuna-ST
Source
Sleep 2009 Jun; 32(6):799-806
NIOSHTIC No.
20035550
Abstract
STUDY OBJECTIVES: Adherence to continuous positive airway pressure (CPAP) therapy for obstructive sleep apnea is poor. Risk factors for nonadherence are not well understood but may reflect individual or neighborhood socioeconomic factors. We sought to determine the association of socioeconomic status and initial CPAP adherence. DESIGN: Retrospective cohort study, 2005 to 2006. SETTING: Philadelphia VA Medical Center. PARTICIPANTS: Of 330 consecutive veterans who met study criteria for initiation of CPAP therapy for newly diagnosed sleep apnea, 266 had complete data for study inclusion. Interventions: N/A. MEASUREMENTS: Through a multivariable logistic regression model, using an outcome of objectively measured CPAP use - 4 h daily during the first week of treatment, we tested whether patients from higher socioeconomic neighborhoods had higher CPAP adherence. We measured neighborhood socioeconomic status with an index derived from the 2000 U.S. Census at the block group-level composed of median household income, male and female employment, adult high school completion, married households, and minority composition. RESULTS: CPAP adherence > 4 h occurred on 48.9% of 1,805 patient-days observed for the 266 subjects. After adjustment for individual sociodemographic characteristics and medical comorbidity, the probability of daily CPAP use 4 h ranged from 34.1% (95% CI, 26.4-42.7) for subjects from a low socioeconomic neighborhood (5th percentile) to 62.3% (95% CI, 53.8-70.1) for subjects from a high (95th percentile) neighborhood. CONCLUSIONS: In a retrospective cohort of veterans, initial CPAP adherence was closely associated with higher neighborhood socioeconomic factors. Future investigation should target specific impediments to adherence in the home and neighborhood environment.
Keywords
Breathing; Demographic-characteristics; Education; Inhalation-studies; Pulmonary-function; Pulmonary-system-disorders; Respiratory-equipment; Sex-factors; Sex-factors; Sleep-disorders; Sleep-disorders; Sociological-factors; Statistical-analysis; Author Keywords: Obstructive sleep apnea; continuous positive airway pressure; adherence; socioeconomic status
Contact
Alec B. Platt, MD, MSCE, 2608 Keiser Blvd.,Wyomissing, PA 19610
CODEN
SLEED6
Publication Date
20090601
Document Type
Journal Article
Email Address
alecplatt@gmail.com
Funding Type
Grant
Fiscal Year
2009
NTIS Accession No.
NTIS Price
Identifying No.
Grant-Number-R01-OH-009149
Issue of Publication
6
ISSN
0161-8105
Source Name
Sleep
State
PA; NC; MD
Performing Organization
University of Pennsylvania
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