Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comment
. 2018 Oct 15;14(10):1645-1652.
doi: 10.5664/jcsm.7364.

The Effect of Sleeping Environment and Sleeping Location Change on Positive Airway Pressure Adherence

Han Yu S Liou  1 , Vishesh K Kapur  2 , Flavia Consens  3 , Martha E Billings  2
Affiliations
Comment

The Effect of Sleeping Environment and Sleeping Location Change on Positive Airway Pressure Adherence

Han Yu S Liou et al. J Clin Sleep Med. .

Abstract

Study objectives: Poor adherence undermines the effectiveness of positive airway pressure (PAP) therapy for sleep apnea. Disparities exist in PAP adherence by race/ethnicity and neighborhood socioeconomic status (SES), but the etiology of these differences is poorly understood. We investigated whether home environmental factors contribute to PAP adherence and whether identified factors explain disparities in adherence by SES.

Methods: Adult patients with sleep apnea were surveyed at clinic visits about their sleep environment. Medical records were abstracted for demographic data, sleep apnea severity, comorbidities, and objective PAP adherence. We evaluated the association between aspects of home sleep environment with PAP adherence using multivariate linear and logistic regression, and assessed effect modification by SES factors.

Results: Participants (n = 119) were diverse, with 44% nonwhite and 35% uninsured/Medicaid. After adjusting for age, sex, race/ethnicity, insurance, neighborhood SES, education, and marital status, participants who endorsed changing sleeping location once per month or more (18%, n = 21) had 77% lower odds of meeting PAP adherence criteria (> 4 h/night for 70% of nights) and less PAP use (median -11 d/mo, 95% confidence intervals -15.3, -6.5). Frequency of sleeping location change was the only environmental factor surveyed associated with PAP adherence.

Conclusions: Frequent change in sleeping location is associated with reduced PAP adherence, independent of sociodemographic factors. This novel finding has implications for physician-patient dialogue. PAP portability considerations in device selection and design may modify adherence and potentially improve treatment outcomes. Prospective investigation is needed to confirm this finding and inform design of possible interventions.

Keywords: CPAP; OSA; environment; housing; positive airway pressure; sleep apnea; socioeconomic status; treatment adherence.

PubMed Disclaimer

Comment on

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol. 2013;177(9):1006–1014. - PMC - PubMed
    1. Kapur VK. Obstructive sleep apnea: diagnosis, epidemiology, and economics. Respir Care. 2010;55(9):1155–1167. - PubMed
    1. Weaver TE, Maislin G, Dinges DF, et al. Relationship between hours of CPAP use and achieving normal levels of sleepiness and daily functioning. Sleep. 2007;30(6):711–719. - PMC - PubMed
    1. Campos-Rodriguez F, Queipo-Corona C, Carmona-Bernal C, et al. Continuous positive airway pressure improves quality of life in women with obstructive sleep apnea. A randomized controlled trial. Am J Respir Crit Care Med. 2016;194(10):1286–1294. - PubMed
    1. Marin JM, Carrizo SJ, Vicente E, Agusti AG. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet. 2005;365(9464):1046–1053. - PubMed

Publication types