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Cited by 44Obstructive Sleep Apnea ResearchSleep and related disordersRespiratory Support and Mechanisms

Is the Relationship between Race and Continuous Positive Airway Pressure Adherence Mediated by Sleep Duration?

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Billings, Martha E., Rosen, Carol L., Wang, Rui, Auckley, Dennis, Benca, Ruth, Foldvary-Schaefer, Nancy, Iber, Conrad, Zee, Phyllis +2 more·2013·SLEEP
DOI 10.5665/sleep.2376PMC PMC3543052
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Abstract

STUDY OBJECTIVES: Black race has been associated with decreased continuous positive airway pressure (CPAP) adherence. Short sleep duration, long sleep latency, and insomnia complaints may affect CPAP adherence as they affect sleep and opportunity to use CPAP. We assessed whether self-reported sleep measures were associated with CPAP adherence and if racial variations in these sleep characteristics may explain racial differences in CPAP adherence. DESIGN: Analysis of data from a randomized controlled trial (HomePAP), which investigated home versus laboratory-based diagnosis and treatment of obstructive sleep apnea. SETTING: Seven American Academy of Sleep Medicine-accredited sleep centers in five cities in the United States. PATIENTS OR PARTICIPANTS: Enrolled subjects (n = 191) with apnea-hypopnea index ≥ 15 and sleepiness (Epworth Sleepiness Scale > 12). INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: Multivariable regression was used to assess if subjective sleep measures and symptoms predicted 3-mo CPAP use. Mediation analysis was used to assess if sleep measures mediated the association of race with CPAP adherence. Black participants reported shorter sleep duration and longer sleep latency at baseline than white and Hispanic participants. Shorter sleep duration and longer sleep latency predicted worse CPAP adherence. Sleep duration mediated the association of black race with lower CPAP adherence. However, insomnia symptoms were not associated with race or CPAP adherence. CONCLUSIONS: Among subjects with similar severity of obstructive sleep apnea and sleepiness, baseline self-reported sleep duration and latency, but not perceived insomnia, predicted CPAP adherence over 3 mo. Sleep duration explains some of the observed differences in CPAP use by race. Sleep duration and latency should be considered when evaluating poor CPAP adherence. CLINICAL TRIAL INFORMATION: PORTABLE MONITORING FOR DIAGNOSIS AND MANAGEMENT OF SLEEP APNEA (HOMEPAP) URL: http://clinicaltrials.gov/show/NCT00642486. NIH clinical trials registry number: NCT00642486.

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  • CPAP adherence is influenced by race, with reduced adherence reported in Black, Hispanic, and Asian Pacific Islander users compared to white users.

    “CPAP adherence is also influenced by race, with reduced adherence reported in Black, Hispanic, and Asian Pacific Islander users compared to white users.1108–1112”

    From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [1110]

    The Discussion (p. 221–227; specific page unavailable in our copy) reports lower CPAP adherence among Black participants, and the Results report lower CPAP use among Black than non-Black participants. The paper does not report reduced adherence for Hispanic or Asian Pacific Islander users compared with white users. Its findings establish an association, rather than showing that race itself causes reduced adherence. (LLM, conf=0.90)

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Authors
Billings, M. E., Rosen, C. L., Wang, R., Auckley, D., Benca, R., Foldvary-Schaefer, N., Iber, C., Zee, P., Redline, S., & Kapur, V. K.
Affiliations
  • University of Washington (US)
  • Rainbow Babies & Children's Hospital (US)
  • Brigham and Women's Hospital (US)
  • MetroHealth Medical Center (US)
  • University of Wisconsin–Madison (US)
  • University of Minnesota (US)
  • Northwestern University (US)
Corresponding author
Billings, Martha E.
ORCID
Venue
SLEEP
Publisher
Oxford University Press (OUP)
Published
2013-02-01
Volume
36
Issue
2
Pages
221-7
ISSN
  • 0161-8105 (ISSN-L)
  • 1550-9109
DOI
10.5665/sleep.2376
PMC
PMC3543052
OpenAlex
W2068330183
Cited by
44
References
0
Citations by year
2025: 1 · 2024: 5 · 2023: 3 · 2022: 3 · 2021: 3 · 2020: 2 · 2019: 3 · 2018: 3 · 2017: 1 · 2016: 4 · 2015: 8 · 2014: 3 · 2013: 4
FWCI
4.41
Type
journal article
Language
en
Open access
Locations
  • SLEEP (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
Keywords
CPAP adherence, race, sleep duration, sleep latency, obstructive sleep apnea, racial disparities, insomnia, mediation analysis, Black patients, Hispanic patients
MeSH terms
Female, Hispanic or Latino, Humans, Male, Middle Aged, Patient Compliance, Sleep, Time Factors, Sleep Apnea, Obstructive, Black People, White People, Racial Groups, Continuous Positive Airway Pressure

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