Discrimination Predicts Suboptimal Adherence to CPAP Treatment and Mediates Black-White Differences in Use

Area of Science:

• Sleep Medicine
• Health Disparities
• Psychosocial Factors in Health

Background:

• Racial and ethnic disparities in continuous positive airway pressure (CPAP) adherence for obstructive sleep apnea (OSA) are well-documented.
• However, the specific impact of perceived racial discrimination on CPAP usage remains understudied.

Purpose of the Study:

• To investigate if Black adults with OSA report higher levels of discrimination than non-Hispanic White adults.
• To determine if discrimination is independently associated with reduced CPAP adherence over time.
• To examine whether discrimination mediates the relationship between Black race and CPAP usage.

Main Methods:

• Prospective study of Black and non-Hispanic White adults with OSA initiating CPAP.
• Utilized the Everyday Discrimination Scale (EDS) to measure perceived discrimination.
• Employed linear regression to analyze the association between race, discrimination, and CPAP usage at 30 and 90 days, with adjustments for psychosocial factors.

Main Results:

• Black adults reported experiencing racial discrimination more frequently than White adults.
• Self-identified Black race was associated with significantly lower mean daily CPAP usage at 30 and 90 days, even after accounting for discrimination.
• Increased perceived discrimination was independently associated with decreased CPAP usage at both 30 and 90 days.

Conclusions:

• Perceived racial discrimination is a significant factor contributing to reduced CPAP adherence in adults with OSA.
• Interventions addressing discrimination may be crucial for improving CPAP usage and health outcomes in minority populations with OSA.