title: Determinants of continuous positive airway pressure adherence in a sleep clinic cohort of South Florida Hispanic veterans.
abstract: OBJECTIVE
  There are little existing data on continuous positive airway pressure (CPAP) adherence in US Hispanic veterans with obstructive sleep apnea (OSA). Our aim was to describe determinants of 1-month adherence in a sleep clinic cohort of South Florida Hispanic veterans.
  
  
  METHODS
  Hispanic veterans referred to the Miami VA sleep clinic were recruited and completed questionnaires about sleep apnea risk, sleep quality, insomnia symptoms, sleepiness, depression/anxiety, acculturation, personality traits, and cognitions about OSA and CPAP. Individuals at risk for OSA were scheduled for baseline polysomnography (PSG), followed by in-lab CPAP titration or a trial of auto-CPAP. Participants with OSA accepting CPAP therapy were asked to return after 7 and 30 days of treatment for adherence verification and to repeat questionnaires.
  
  
  RESULTS
  One hundred twenty-four participants (94 % men) were enrolled with 114 completing overnight PSG. Eighty-six out of 95 participants (91 %) with sleep apnea syndrome or moderate to severe OSA accepted CPAP treatment. Fifty-nine participants completed both follow-up visits with a mean CPAP use at 30 days of 3.6 ± 2.0 h. The only independent predictor of 7-day mean daily CPAP use was the baseline Insomnia Severity Index while the best predictor of 30-day mean daily CPAP use was the 7-day mean daily use.
  
  
  CONCLUSIONS
  Our study suggests that South Florida Hispanic veterans with OSA evaluated in a sleep clinic show poor CPAP adherence. Insomnia and poor early use predicted poor adherence overall. Larger prospective studies with other race-ethnic groups are needed to determine the role of ethnicity and race in CPAP adherence among US veterans with OSA.
authors.affiliation: Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA. dwallace@med.miami.edu
authors.forename: D M
authors.initials: DM
authors.lastname: Wallace
authors.forename: S S
authors.initials: SS
authors.lastname: Vargas
authors.forename: S J
authors.initials: SJ
authors.lastname: Schwartz
authors.forename: M S
authors.initials: MS
authors.lastname: Aloia
authors.forename: S
authors.initials: S
authors.lastname: Shafazand
mesh_terms: D000069:Acculturation; D000328:Adult; D000554:Ambulatory Care Facilities; D015331:Cohort Studies; D015897:Comorbidity; D045422:Continuous Positive Airway Pressure / Q000523:psychology*; D005260:Female; D005431:Florida; D006630:Hispanic or Latino / Q000208:ethnology* / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017286:Polysomnography / Q000523:psychology; D020181:Sleep Apnea, Obstructive / Q000208:ethnology* / Q000523:psychology / Q000628:therapy*; D014728:Veterans / Q000523:psychology*