• Martha E Billings, Dennis Auckley, Ruth Benca, Nancy Foldvary-Schaefer, Conrad Iber, Susan Redline, Carol L Rosen, Phyllis Zee, and Vishesh K Kapur.
• Health Services Research & Development, Department of Veterans Affairs, Puget Sound Health Care System, 1100 Olive Way, Suite 1400, Seattle, WA 98101, USA. mebillin@uw.edu
• Sleep. 2011 Dec 1;34(12):1653-8.

Study ObjectivesThere 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.DesignA multi-center randomized trial of home vs. lab-based evaluation and treatment of OSA assessing adherence to CPAP at 1 and 3 months.SettingSeven AASM-accredited sleep centers in 5 U.S. cities.ParticipantsSubjects 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).Measurements And ResultsSubjects' 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.ConclusionBlack 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.

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