Adherence to positive airway pressure treatment among minority populations in the US: A scoping review

Abstract

Minority individuals in the United States (US) have an increased prevalence of obstructive sleep apnea (OSA) compared to their white/Caucasian counterparts. In general, adherence to positive airway pressure (PAP) therapy is poor and some studies suggest that PAP use among minority individuals is inferior to that of whites. However, there has not been a review of the evidence that addresses racial-ethnic disparities for PAP adherence in the treatment of OSA, and no review has systematically examined the contributing factors to poor adherence among minority individuals compared to whites. We searched the literature for studies published between January 1990 to July 2016 that included objective PAP use comparisons between adult US minority individuals and whites. Twenty-two studies met the inclusion criteria. All studies compared the PAP adherence of blacks to whites. Seven studies compared the PAP adherence of additional minority groups to that of whites. Sixteen of the 22 studies (73%) showed worse PAP adherence in blacks compared to whites. Four studies found equivalent PAP use in US Hispanics compared to whites. Little is known about the PAP adherence of other US minority groups. We present a framework and research agenda for understanding PAP use barriers among US minority individuals.

Keywords: Adherence; Compliance; Ethnicity; Health disparities; Obstructive sleep apnea; Positive airway pressure; Race; Treatment.

Figure 1:

PRISMA flow diagram

Figure 2.

Barriers and testable strategies to improve PAP adherence among US minorities A=Preceding presentation to health care system; B=OSA assessment by primary care provider or sleep provider; C=Diagnostic testing for OSA; D=Positive airway pressure treatment recommendation and initiation; E=Follow-up care for OSA and positive airway pressure treatment. Abbreviations- I, individual-level; P, provider-level; HC, health care system-level; EB, evidence-based; H, hypothesized; PAP, positive airway pressure; PSG, polysomnogram.