Williams Natasha J, Jean-Louis Girardin, Pandey Abhishek, Ravenell Joseph, Boutin-Foster Carla, Ogedegbe Gbenga
Center for Healthful Behavior Change, Division of Internal Medicine, NYU Medical Center, New York, USA.
Department of Family Medicine, SUNY Downstate Medical Center, Brooklyn, USA.
Patient Prefer Adherence. 2014 Mar 11;8:283-7. doi: 10.2147/PPA.S53617. eCollection 2014.
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.
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.
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).
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.
日间过度嗜睡（EDS）常因睡眠不足、睡眠呼吸暂停、非法药物使用以及其他医学和精神疾病而发生。本研究利用“咨询非裔美国人控制高血压”（CAATCH）试验的横断面数据，检验了表现出EDS的黑人自我报告的高血压药物依从性较差这一假设。
共有1058名高血压黑人（平均年龄57±12岁）参与了CAATCH试验，这是一项随机对照试验，评估针对从纽约市社区卫生中心接受治疗的参与者的多级干预措施的有效性。本研究分析的数据包括基线社会人口统计学、病史、EDS和药物依从性。我们使用爱泼华嗜睡量表，以≥10的临界值来定义EDS。使用简化的莫里isky药物依从性量表测量药物依从性，得分>0表明不依从。
在样本中，71%为女性，72%至少接受过高中教育，51%报告有吸烟史，33%有饮酒史。总体而言，27%的参与者表现出EDS，表现出EDS的参与者中有44%被归类为坚持服用规定的抗高血压药物。多变量逻辑回归分析在调整了年龄、体重指数、性别、教育程度以及吸烟和饮酒史的影响后表明，表现出EDS的参与者不依从的可能性是前者的两倍多（比值比2.28，95%置信区间1.42 - 3.67，P<0.001）。
对CAATCH数据的分析表明，高血压黑人中EDS的患病率很高。EDS是高血压患者不坚持服用规定药物的一个重要预测因素。这些发现指出了一个可改变的变量，可在未来针对药物依从性的干预措施中作为目标。
