Obstructive Sleep Apnea (OSA) has a disparate impact on the African American Community according to studies published by the Mayo Clinic, Harvard Medical School, Brigham and Woman’s Hospital and other sources.

OSA is linked to day-time fatigue, cardio-vascular diseases, diabetes, cancer, and other chronic illnesses. Worse yet, the literature indicates that African Americans have much greater difficulty adapting to the traditional CPAP treatment for OSA (i.e. sleeping with a face mask, air tubes, and bed-side flow generator) and have a high likelihood of discontinuing use.

These are just a few of the sources confirming these unfortunate findings:
1. Mayo Clinic – OSA Risk Factors: Being black. Among people under age 35, obstructive sleep apnea is more common in blacks. http://www.mayoclinic.org/diseases-conditions/obstructive-sleep-apnea/basics/risk-factors/con-20027941

2. NY Times: African-Americans face a higher risk for sleep apnea than any other ethnic group in the United States. http://www.nytimes.com/health/guides/disease/sleep-apnea/risk-factors.html

3. Harvard Medical School and Brigham and Woman’s Hospital: CPAP Use Among African Americans With Obstructive Sleep Apnea – “Among African Americans with OSA low self-efficacy appeared to be associated with discontinuation of CPAP use. The effect size of this relationship was large ” http://tinyurl.com/l8ql9c9

Katherine A. Dudley , M.D. 1 , Jessie P. Bakker , PhD 1 , Guido Simonelli , Medical Student 2 , Sanjay R. Patel , MD 1 , , 3 ,
Read More: http://www.atsjournals.org/doi/abs/10.1164/ajrccm-conference.2014.189.1_MeetingAbstracts.A5624

2014

Rationale:

There is evidence to suggest that African Americans with obstructive sleep apnea (OSA) have markedly lower rates of continuous positive airway pressure (CPAP) adherence than Caucasians. In this pilot study, we sought to identify predictors of low CPAP adherence among African Americans.

Methods:
African American OSA patients initiated on CPAP therapy were recruited from the community and divided into active  and non-active users based on compliance data. A questionnaire battery including the Self Efficacy Measure of Sleep Apnea (SEMSA), Medical Outcomes Study, social support study, Rapid Estimate of Adult Literacy in Medicine, Beck’s Depression Inventory, and Epworth Sleepiness Scale were administered. T-tests were used to compare a means responses between groups and Cohen’s d was used to assess effect sizes.

Results:
Thus far, nine African American subjects have completed the study. Five are active CPAP users and four are not actively using CPAP. Mean (+/- standard deviation) age is 52.7 +/- 6.4 yrs, mean body mass index is 35.0 +/- 7.0 kg/m², 44.4% are male, and the mean AHI is 35.3 +/- 17.2 events/hr. There were no statistically significant differences between active and non-active CPAP users. Based on the SEMSA, risk perception (d=0.47, p=0.50) and outcome expectations (d-0.12, p=0.86) did not differ between active and non-active CPAP users. In contrast, a trend  was observed for greater self-efficacy among active CPAP users compared with non-active (d=1.61, p=0.08). No statistically significant differences were detected in measures of social support, health literacy, depressive symptoms or sleepiness.

Conclusions:
Among African Americans with OSA, low self-efficacy appeared to be associated with discontinuation of CPAP use. The effect size of this relationship was large, suggesting clinical relevance. Interventions targeting self-efficacy may have a role in improving CPAP adherence among African Americans.

This abstract is funded by: NIH Grant 5T32HL007901-15
Am J Respir Crit Care Med 189;2014:A5624
Internet address: www.atsjournals.org