Health Services Research & Development, Department of Veterans Affairs, Puget Sound Health Care System, 1100 Olive Way, Suite 1400, Seattle, WA 98101, USA.
Sleep. 2011 Dec 1;34(12):1653-8. doi: 10.5665/sleep.1428.
There are few established predictors of CPAP adherence; poor adherence limits its effectiveness. We investigated whether race, education level, and residential economic status predict CPAP adherence in participants enrolled in a trial with standard access to treatment.
A multi-center randomized trial of home vs. lab-based evaluation and treatment of OSA assessing adherence to CPAP at 1 and 3 months.
Seven AASM-accredited sleep centers in 5 U.S. cities.
Subjects with moderate to severe OSA (AHI ≥ 15 and Epworth Sleepiness Scale score > 12) who completed follow-up at 1 and/or 3 months (n = 135).
Subjects' demographic data were collected upon enrollment; CPAP use at 1 and 3 months was assessed at clinic follow-up. In unadjusted analyses, CPAP adherence (average minutes per night of CPAP use) at 3 months was lower in black subjects and in subjects from lower socioeconomic status ZIP codes. In adjusted analyses using multivariate linear regression, black race was predictive of CPAP adherence at one month (P = 0.03). At 3 months, black race was predictive in analyses only when ZIP code SES was not adjusted for.
Black race and lower socioeconomic residential areas are associated with poorer adherence to CPAP in subjects with standardized access to care and treatment. Disparities remain despite provision of standardized care in a clinical trial setting. Future research is needed to identify barriers to adherence and to develop interventions tailored to improve CPAP adherence in at risk populations. Portable Monitoring for Diagnosis and Management of Sleep Apnea (HomePAP) CLINICAL TRIAL INFORMATION: NIH CLINICAL TRIALS REGISTRY NUMBER: NCT00642486. URL: http://clinicaltrials.gov/show/NCT00642486.
目前预测 CPAP 依从性的指标有限，而 CPAP 依从性差会限制其疗效。我们调查了在一项标准治疗可及性试验中，种族、教育水平和居住经济状况是否可预测 CPAP 依从性。
一项多中心、随机试验，比较家庭和实验室评估及治疗 OSA 患者，评估 CPAP 治疗 1 个月和 3 个月时的依从性。
美国 5 个城市的 7 个 AASM 认证的睡眠中心。
完成 1 个月和/或 3 个月随访的中重度 OSA 患者（AHI≥15 且 Epworth 嗜睡量表评分>12）（n=135）。
在登记时收集受试者的人口统计学数据；在临床随访时评估 CPAP 使用 1 个月和 3 个月时的情况。在未调整分析中，黑人受试者和社会经济地位较低的邮政编码区（ZIP 码）受试者的 CPAP 依从性（CPAP 使用的平均每晚分钟数）较低。在使用多元线性回归的调整分析中，黑种人种族是 1 个月 CPAP 依从性的预测因素（P=0.03）。在 3 个月时，仅当不调整 ZIP 码 SES 时，黑种人种族才是预测因素。
在标准化医疗和治疗可及的情况下，黑种人种族和较低的社会经济居住地区与 CPAP 依从性较差相关。尽管在临床试验环境中提供了标准化治疗，但仍然存在差异。需要进一步研究以确定依从性障碍，并制定针对高危人群改善 CPAP 依从性的干预措施。便携式监测用于睡眠呼吸暂停的诊断和管理（HomePAP）临床试验信息：NIH 临床试验注册编号：NCT00642486。网址：http://clinicaltrials.gov/show/NCT00642486。
