title: The association of age, insomnia, and self-efficacy with continuous positive airway pressure adherence in black, white, and Hispanic U.S. Veterans.
abstract: OBJECTIVE
  Studies of continuous positive airway pressure (CPAP) adherence in multi-ethnic samples are lacking. This study explores previously described factors associated with therapeutic CPAP use in South Florida veterans with obstructive sleep apnea-hypopnea syndrome (OSAHS).
  
  
  METHODS
  We performed a retrospective, cross-sectional analysis of CPAP adherence comparing white, black, and Hispanic veterans returning to the Miami VA sleep clinic over a 4-month period. Participants had CPAP use download and completed questionnaires on demographics, sleepiness, insomnia, and social cognitive measures related to adherence. Linear regression modeling was used to explore the impact of measured variables and potential interactions with race-ethnicity on mean daily CPAP use.
  
  
  RESULTS
  Participants (N = 248) were 94% male with mean age of 59 ± 11 years and included 95 blacks (38%), 91 whites (37%), and 62 Hispanic (25%) veterans. Blacks had less mean daily CPAP use than whites (-1.6 h, p < 0.001) and Hispanics (-1.3 h, p < 0.01). Blacks reported worse sleep onset insomnia symptoms compared to whites. In the final multivariable regression model, black race-ethnicity (p < 0.01), insomnia symptoms (p < 0.001), and self-efficacy (p < 0.001) were significantly associated with mean daily CPAP use. In addition, the black race by age interaction term showed a trend towards significance (p = 0.10).
  
  
  CONCLUSIONS
  In agreement with recent studies, we found that mean daily CPAP use in blacks was 1 hour less than whites after adjusting for covariates. No CPAP adherence differences were noted between whites and Hispanics. Further investigations exploring sociocultural barriers to regular CPAP use in minority individuals with OSAHS are needed.
authors.affiliation: Department of Neurology, Sleep Medicine Division, University of Miami Miller School of Medicine, Miami, FL, USA. dwallace@med.miami.edu
authors.forename: Douglas M
authors.initials: DM
authors.lastname: Wallace
authors.forename: Shirin
authors.initials: S
authors.lastname: Shafazand
authors.forename: Mark S
authors.initials: MS
authors.lastname: Aloia
authors.forename: William K
authors.initials: WK
authors.lastname: Wohlgemuth
mesh_terms: D000367:Age Factors; D044383:Black People / Q000523:psychology / Q000706:statistics & numerical data*; D045422:Continuous Positive Airway Pressure / Q000523:psychology*; D005260:Female; D006630:Hispanic or Latino / Q000523:psychology / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000208:ethnology / Q000706:statistics & numerical data*; D020377:Self Efficacy; D020181:Sleep Apnea, Obstructive / Q000208:ethnology / Q000523:psychology / Q000628:therapy; D007319:Sleep Initiation and Maintenance Disorders / Q000523:psychology*; D014481:United States / Q000453:epidemiology; D014728:Veterans / Q000523:psychology* / Q000706:statistics & numerical data; D044465:White People / Q000523:psychology / Q000706:statistics & numerical data*; D001741:Black or African American
keywords: Veterans; adherence; continuous positive airway pressure; insomnia; race-ethnicity; sleep apnea