title: Excessive daytime sleepiness and adherence to antihypertensive medications among Blacks: analysis of the counseling African Americans to control hypertension (CAATCH) trial.
abstract: BACKGROUND
  Excessive daytime sleepiness (EDS) often occurs as a result of insufficient sleep, sleep apnea, illicit substance use, and other medical and psychiatric conditions. This study tested the hypothesis that blacks exhibiting EDS would have poorer self-reported adherence to hypertensive medication using cross-sectional data from the Counseling African-Americans to Control Hypertension (CAATCH) trial.
  
  
  METHODS
  A total of 1,058 hypertensive blacks (average age 57±12 years) participated in CAATCH, a randomized controlled trial evaluating the effectiveness of a multilevel intervention for participants who receive care from community health centers in New York City. Data analyzed in this study included baseline sociodemographics, medical history, EDS, and medication adherence. We used the Epworth Sleepiness Scale, with a cutoff score of ≥10, to define EDS. Medication adherence was measured using an abbreviated Morisky Medication Adherence scale, with a score >0 indicating nonadherence.
  
  
  RESULTS
  Of the sample, 71% were female, 72% received at least a high school education, 51% reported a history of smoking, and 33% had a history of alcohol consumption. Overall, 27% of the participants exhibited EDS, and 44% of those who exhibited EDS were classified as adherent to prescribed antihypertensive medications. Multivariable logistic regression analysis, adjusting for effects of age, body mass index, sex, education, and smoking and drinking history indicated that participants who exhibited EDS were more than twice as likely to be nonadherent (odds ratio 2.28, 95% confidence interval 1.42-3.67, P<0.001).
  
  
  CONCLUSIONS
  Analysis of the CAATCH data showed a high prevalence of EDS among hypertensive blacks. EDS is a significant predictor of nonadherence to prescribed medications for hypertension. These findings point to a modifiable variable that can be targeted in future interventions focusing on medication adherence.
authors.affiliation: Center for Healthful Behavior Change, Division of Internal Medicine, NYU Medical Center, New York, USA.
authors.forename: Natasha J
authors.initials: NJ
authors.lastname: Williams
authors.affiliation: Center for Healthful Behavior Change, Division of Internal Medicine, NYU Medical Center, New York, USA.
authors.forename: Girardin
authors.initials: G
authors.lastname: Jean-Louis
authors.affiliation: Department of Family Medicine, SUNY Downstate Medical Center, Brooklyn, USA.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Pandey
authors.affiliation: Center for Healthful Behavior Change, Division of Internal Medicine, NYU Medical Center, New York, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Ravenell
authors.affiliation: Center of Excellence in Disparities Research, Weill Cornell Medical College, New York, NY, USA.
authors.forename: Carla
authors.initials: C
authors.lastname: Boutin-Foster
authors.affiliation: Center for Healthful Behavior Change, Division of Internal Medicine, NYU Medical Center, New York, USA.
authors.forename: Gbenga
authors.initials: G
authors.lastname: Ogedegbe
keywords: blacks; excessive daytime sleepiness; hypertension; medication adherence