title: Commercial Motor Vehicle Driver Positive Airway Pressure Therapy Adherence in a Sleep Center.
abstract: OBJECTIVE
  To assess positive airway pressure (PAP) therapy adherence in commercial motor vehicle (CMV) drivers presenting to a sleep center.
  
  
  METHODS
  A retrospective chart review of 120 drivers evaluated for obstructive sleep apnea OSA and 53 initiated on PAP therapy in a single sleep center over a one-year period (2012); PAP therapy data were collected up to 1 year.
  
  
  RESULTS
  Early PAP usage best predicted adherence up to 1 year (p < 0.0001) compared to patient factors, OSA disease characteristics, and treatment elements analyzed. The proportion of participants adherent to therapy was 68.0% at 1 week, decreasing to 39.6% at 1 year, with 31.1% lost to follow-up by 1 year. In the group categorized based on adherence at week 1, 80.6% were adherent at 1 month, decreasing to 52.8% at 1 year. For the group non-adherent at 1 week, 29.4% were adherent at 1 month, decreasing to 11.7% at 1 year. Participants were predominantly male (75.8%), middle-aged (median 50.5 years), and African American (71.7%). Of those referred to the sleep center, 86.7% had OSA (median apnea-hypopnea index [AHI] or respiratory event index [REI] 20.1), with 51.0% of the OSA group having an AHI or REI > 20 and initiating PAP therapy.
  
  
  CONCLUSIONS
  Early PAP utilization patterns predicted one year adherence for our CMV driver population within a sleep clinic setting. OSA testing of these CMV drivers after occupational health referral identifies high proportions of undiagnosed OSA, with approximately half requiring PAP therapy based on current published treatment recommendations.
authors.affiliation: Maryville University, St. Louis, MO.|Clayton Sleep Institute, St. Louis, MO.
authors.forename: Loretta J
authors.initials: LJ
authors.lastname: Colvin
authors.affiliation: Southeast Health, St. Louis, MO.
authors.forename: Gayla A
authors.initials: GA
authors.lastname: Dace
authors.affiliation: Washington University, St. Louis, MO.
authors.forename: Ryan M
authors.initials: RM
authors.lastname: Colvin
authors.affiliation: Clayton Sleep Institute, St. Louis, MO.
authors.forename: Joseph
authors.initials: J
authors.lastname: Ojile
authors.affiliation: Emory Sleep Center, Emory University, Atlanta, GA.
authors.forename: Nancy
authors.initials: N
authors.lastname: Collop
mesh_terms: D000328:Adult; D001334:Automobile Driving; D045422:Continuous Positive Airway Pressure / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018986:Motor Vehicles; D010349:Patient Compliance / Q000706:statistics & numerical data*; D017286:Polysomnography / Q000706:statistics & numerical data; D012189:Retrospective Studies; D020181:Sleep Apnea, Obstructive / Q000628:therapy*; D016896:Treatment Outcome
keywords: Federal Motor Carrier Safety Administration; adherence; commercial motor vehicle; continuous positive airway pressure; driver; obstructive sleep apnea; positive airway pressure; sleep apnea