CPAP adherence varies by neighborhood racial composition

CPAP adherence was lower in neighborhoods with greater proportions of Black and Hispanic residents, according to data published in the American Journal of Respiratory Critical Care Medicine.

“Given increasing evidence of structural barriers to health care, disparities at the community level likely contribute to racial disparities in obstructive sleep apnea but will not be fully captured by single-site analyses,” Priya V. Borker, MD, fellow in the Center for Sleep and Cardiovascular Outcomes Research and the division of pulmonary, allergy and critical care medicine at the University of Pittsburgh, and colleagues wrote. “In order to address sleep health disparities and improve health equity in OSA-related comorbidities it is imperative to understand disparities in CPAP adherence.”

Researchers evaluated telemonitoring data from a CPAP manufacturer database to assess adherence among 787,236 adult patients with OSA who initiated CPAP therapy with a Philips Respironics device from November 2015 to October 2018. Patients were mapped to 26,180 ZIP code tabulation areas in the U.S. and the researchers evaluated these data along with age- and gender-adjusted CPAP adherence at a neighborhood level as a function of neighborhood racial composition, according to the study.

The prevalence of CPAP adherence was 1.7% lower in neighborhoods with 25% or more Black residents and 1.5% lower in neighborhoods with 25% or more Hispanic residents compared with in neighborhoods with less than 1% of Black of Hispanic residents (P < .001), according to the results. The lower prevalence of adherence persisted after researchers adjusted for differences in poverty and education.

Rates of mean CPAP usage across all neighborhoods were similar in the first 2 days after initiating therapy. However, at 90 days, CPAP usage increased to a 22-minute difference between neighborhoods with high populations of Black residents and a 22-minute difference between neighborhoods with high populations of Hispanic residents, compared with neighborhoods with low populations of Black and Hispanic residents (P < .001 for both), according to the results.

In the first 90 days, the prevalence of nights without CPAP use was higher in neighborhoods with the greatest proportions of Black and Hispanic residents compared with neighborhoods with the lowest proportions of Black and Hispanic residents, the researchers reported.

“Furthermore, because CMS policies deny CPAP coverage for patients who do not achieve 90-day adherence, a policy widely adopted by private payers, these differences likely translate into even greater disparities beyond 90 days as greater proportions of patients in high-prevalence minority neighborhoods are denied long-term coverage of CPAP therapy,” the researchers wrote.

The researchers noted several limitations of this study, including analysis of data from only one CPAP manufacturer.

The researchers concluded that the findings of this study have important implications.

“Black and Hispanics are at much higher risk of consequences from untreated OSA, including higher burdens of excessive daytime sleepiness, drowsy driving, and cardiovascular morbidity and mortality. As a result, these communities would potentially derive greater benefit from effective OSA treatment. Therefore, interventions to reduce the disparities in CPAP adherence identified would advance sleep health equity and decrease inequities in these downstream consequences. Further research to understand the causes of racial disparities in CPAP adherence will be vital to develop such interventions,” they wrote.