Experiences with Continuous Positive Airway Pressure Among African American Patients and their Bed Partners

ABSTRACT

Rationale

Despite having a higher prevalence and severity of obstructive sleep apnea (OSA), African Americans have lower adherence to continuous positive airway pressure (CPAP) compared to other groups. Information regarding challenges faced by African Americans prescribed CPAP are lacking.

Objectives

To determine the barriers and facilitators to optimal management of OSA with CPAP among African Americans and to understand the role bed partners may play.

Methods

We conducted semi-structured in-depth interviews via video conferencing with African American patients of an urban safety-net health care system with OSA prescribed CPAP and their bed partners. Recruitment continued until theoretical saturation was achieved. Verbatim transcripts were analyzed using the principles of thematic analysis.

Results

15 patients (12 women) diagnosed with OSA and prescribed CPAP a mean 2.6 years prior along with 15 bed partners (3 women) were individually interviewed. Four themes emerged regarding impediments to CPAP use: 1) inadequate education and support, 2) CPAP maintenance and hygiene, 3) inconvenient design of CPAP interfaces, and 4) impediment to intimacy. Four themes emerged as facilitators to CPAP use: 1) provider and technical support, 2) properly fitted CPAP masks, 3) active support from partner and family, and 4) experiencing positive results from CPAP.

Conclusions

African American patients with OSA and their bed partners identified several unique barriers and facilitators to CPAP use. Active involvement by bed partners was considered by both patients and partners as helpful in improving CPAP adherence. Interventions to improve OSA outcomes in this population should focus on patients and their bed partners.

Author contributions

All authors contributed to study concept, design, analysis, interpretation of the data, and drafting of the manuscript. Kristen Berg and J. Daryl Thornton had full access to all data in the study and take responsibility for the integrity of the data and accuracy of the analysis.

All authors have seen and approved the manuscript which does not report the results of a clinical trial.

Disclosure Statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by theNational Institutes of Health National Center for Advancing Translational Sciences [UL1TR002548] and National Institute on Minority Health and Health Disparities [U54MD002265].

Notes on contributors

Adam T. Perzynski

Dr. Perzynski reports equity ownership in Global Health Metrics, LLC and book royalty agreements with Taylor Francis and Springer Nature outside the current work. Dr. Patel has received grant support through his institution from Bayer Pharmaceuticals, Philips Respironics, Respicardia, and Sommetrics.