Neighborhood of Residence is Associated with Daily Adherence to CPAP Therapy
Open accessAbstract
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.
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Increasing data suggest disparities in PAP adherence across socioeconomic and racial groups.
“Since that time, very few studies have examined this relationship, though increasing data suggests disparities exist with PAP adherence across socioeconomic and racial groups1095–1097 and use of the 4-h, 70% threshold may be contributing to reduced access to treatment by rendering users below this threshold ineligible for coverage.”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [1097]
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- Authors
- Platt, A. B., Field, S. H., Asch, D. A., Chen, Z., Patel, N. P., Gupta, R., Roche, D. F., Gurubhagavatula, I., Christie, J. D., & Kuna, S. T.
- Affiliations
- Reading Hospital (US)
- University of North Carolina at Chapel Hill (US)
- Philadelphia VA Medical Center (US)
- National Institutes of Health (US)
- University of Pennsylvania (US)
- Corresponding author
- Platt, Alec B.
- ORCID
- Venue
- Sleep
- Publisher
- Oxford University Press (OUP)
- Published
- 2009-06
- Volume
- 32
- Issue
- 6
- Pages
- 799-806
- ISSN
- 0161-8105 (ISSN-L)
- 1550-9109
- PMC
- PMC2690568
- OpenAlex
- W1515645811
- Cited by
- 128
- References
- 50
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 7 · 2023: 5 · 2022: 8 · 2021: 11 · 2020: 9 · 2019: 4 · 2018: 6 · 2017: 7 · 2016: 7 · 2015: 11 · 2014: 7 · 2013: 12 · 2012: 8
- FWCI
- 6.43
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- SLEEP (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Heart, Lung, and Blood Institute (T32HL007713, T-32 HL07713-14)
- National Institute for Occupational Safety and Health (R01OH009149, R01-OH-009149-01)
- Topics
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Keywords
- CPAP adherence, continuous positive airway pressure, obstructive sleep apnea, neighborhood socioeconomic status, veterans, sleep apnea treatment
- MeSH terms
- Adult, Aged, Female, Humans, Male, Middle Aged, Patient Compliance, Probability, Residence Characteristics, Retrospective Studies, Socioeconomic Factors, United States, Veterans, Cohort Studies, Comorbidity, Multivariate Analysis, Polysomnography, Sleep Apnea, Obstructive, Continuous Positive Airway Pressure
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