title: Sleep apnea in an urban public hospital: assessment of severity and treatment adherence.
abstract: OBJECTIVE
  To assess obstructive sleep apnea (OSA) severity, continuous positive airway pressure (CPAP) adherence, and factors associated with CPAP adherence among a group of patients with OSA receiving care at a publicly funded county hospital.
  
  
  METHODS
  A retrospective cohort study in a 464-bed urban public hospital in Cook County, Illinois.
  
  
  RESULTS
  A total of 507 patients were included. They had a mean (SD) age of 46.9(11) years, mean body mass index of 46.2 (11.0) kg/m2; mean and median baseline apnea-hypopnea index (AHI) of 71.0 (44.4) and 69.5 episodes/h; mean Epworth Sleepiness Scale (ESS) score of 15.8 (6.1). Of these patients, 53% were men, 74% did not have health insurance coverage, and 77% were African American. Mean CPAP adherence of the 323 patients with follow-up data was 3.87 (2.62) hours/ day, with 47.7% of subjects using CPAP objectively for > or = 4 hours/day. Women were 2.49 (95% CI, 1.39-4.46) times more likely to be nonadherent than men, after adjusting for race, marital status, and age. Of the 172 patients who did not follow up, there were disproportionately more men. When individuals without follow-up were assumed to be nonadherent, the overall compliance rate was 30.4%, and women were 1.72 (95% CI, 1.03-2.88) times more likely to be noncompliant than men, adjusting for race, marital status, and age.
  
  
  CONCLUSIONS
  This study population experienced severe OSA. CPAP adherence was low, with women having a higher likelihood of nonadherence than men. With the epidemic of obesity and increased awareness of OSA, this population should be further studied to diminish future health disparities in the treatment of this disease.
authors.affiliation: Section of Pulmonary, Critical Care, and Sleep Medicine, University of Illinois at Chicago, Chicago, IL, USA. joo@uic.edu
authors.forename: Min J
authors.initials: MJ
authors.lastname: Joo
authors.forename: James J
authors.initials: JJ
authors.lastname: Herdegen
mesh_terms: D015992:Body Mass Index; D015331:Cohort Studies; D045422:Continuous Positive Airway Pressure / Q000379:methods* / Q000706:statistics & numerical data*; D003710:Demography; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006779:Hospitals, Public / Q000706:statistics & numerical data*; D006786:Hospitals, Urban / Q000706:statistics & numerical data*; D006801:Humans; D007087:Illinois / Q000453:epidemiology; D007348:Insurance, Health / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy