Is the Relationship between Race and CPAP Adherence Mediated by Sleep Duration?

Abstract

Study Objectives: Black race has been associated with decreased CPAP adherence. Short sleep duration, long sleep latency and insomnia complaints may affect CPAP adherence as they impact sleep and opportunity to use CPAP. We assessed whether self-reported sleep measures were associated with CPAP adherence and if racial variations in these sleep characteristics may explain racial differences in CPAP adherence. Design: Analysis of data from a randomized controlled trial (HomePAP), which investigated home vs. lab based diagnosis and treatment of OSA Setting: Seven AASM-accredited sleep centers in 5 US cities Patients or Participants: Enrolled subjects (N=191) with AHI≥15 and sleepiness (ESS>12) Interventions: N/A Measurements and Results: Multivariable regression was used to assess if subjective sleep measures and symptoms predicted 3 month CPAP use. Mediation analysis was used to assess if sleep measures mediated the association of race with CPAP adherence. Black participants reported shorter sleep duration and longer sleep latency at baseline than white and Hispanic participants. Shorter sleep duration and longer sleep latency predicted worse CPAP adherence. Sleep duration mediated the association of black race with lower CPAP adherence. However, insomnia symptoms were not associated with race or CPAP adherence. Conclusions: Among subjects with similar severity of OSA and sleepiness, baseline self-reported sleep duration and latency, but not perceived insomnia, predicted CPAP adherence over 3 months. Sleep duration explains some of the observed differences in CPAP use by race. Sleep duration and latency should be considered when evaluating poor CPAP adherence. Portable Monitoring for Diagnosis and Management of Sleep Apnea (HomePAP) (http://clinicaltrials.gov/show/NCT00642486) NIH clinical trials registry number: NCT00642486