title: Does race-ethnicity moderate the relationship between CPAP adherence and functional outcomes of sleep in US veterans with obstructive sleep apnea syndrome?
abstract: BACKGROUND
  Little is known about the association of race-ethnicity and the relationship of continuous positive airway pressure (CPAP) adherence with functional outcomes of sleep in American samples with obstructive sleep apnea syndrome (OSAS). This retrospective study examines whether race-ethnicity moderates the relationship between CPAP adherence and functional outcomes of sleep in OSAS.
  
  
  METHODS
  Over 4 months, consecutive OSAS patients had CPAP data downloads and completed questionnaires (demographics, Functional Outcomes of Sleep Questionnaire [FOSQ], Epworth Sleepiness Scale [ESS], Insomnia Severity Index [ISI]) at the Miami VA sleep center. Medical diagnoses and polysomnography data were obtained from medical record. CPAP adherence was measured as mean daily hours of use. Hierarchical regression modeling was used to explore the differential impact of race-ethnicity and CPAP adherence on functional outcomes of sleep.
  
  
  RESULTS
  Two hundred twenty-seven veterans (93% male, age 59 ± 11 years) were included; 142 (63%) participants self-reported as white or Hispanic, and 85 participants (37%) as black. Hierarchical regression analyses failed to show main effects for race-ethnicity or CPAP use and FOSQ scores; however, the interaction of race-ethnicity with CPAP adherence was significantly associated with the total FOSQ (p = 0.04), Social (p = 0.02), and Intimacy (p = 0.01) subscale scores. For blacks, in adjusted analyses, CPAP adherence was positively associated with Social and Intimacy FOSQ subscales; however, no significant relationship was noted between CPAP use and FOSQ scores in whites/Hispanics.
  
  
  CONCLUSIONS
  Race-ethnicity may moderate the relationship between CPAP adherence and some functional outcomes of sleep; however, further studies are needed.
authors.affiliation: Neurology Service, Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, FL ; Department of Neurology, University of Miami Miller School of Medicine, Miami, FL.
authors.forename: Douglas M
authors.initials: DM
authors.lastname: Wallace
authors.affiliation: Department of Neurology, University of Miami Miller School of Medicine, Miami, FL ; Psychology Service, Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, FL.
authors.forename: William K
authors.initials: WK
authors.lastname: Wohlgemuth
mesh_terms: D045422:Continuous Positive Airway Pressure / Q000379:methods / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D017286:Polysomnography / Q000379:methods; D044469:Racial Groups / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D020181:Sleep Apnea, Obstructive / Q000628:therapy*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014481:United States; D014728:Veterans / Q000706:statistics & numerical data*
keywords: adherence; functional outcomes; positive airway pressure; quality of life; race-ethnicity; sleep apnea; veterans