Adult perceptions of the diagnosis and treatment of obstructive sleep apnea: Sociocultural and ethnic influences on adherence outcomes.

摘要

Statement of problem. Adherence to continuous positive airway pressure (CPAP) is critical to health and functional outcomes in treating obstructive sleep apnea (OSA). Recent studies reveal race-based differences in adherence to CPAP, with non-Hispanic African Americans having significantly lower adherence than non-Hispanic Caucasians. In studies examining racial differences in adherence to medication, lower adherence in African Americans was, in part, contributed to by health beliefs, treatment perceptions, and self-efficacy. Race-based differences among CPAP-treated OSA adults may be contributed to by specific health beliefs, diagnosis/treatment perceptions, and self-efficacy. The purpose of this research was to examine differences in beliefs and perceptions about the OSA diagnosis, CPAP treatment, and self-efficacy relative to CPAP adherence among adults with OSA.;Procedure & methods. The study employed a mixed methods concurrent nested design. The predominant method was qualitative with an embedded quantitative data collection procedure. Semi-structured interviews were conducted within one week of diagnosis and after at least one week of CPAP treatment. CPAP adherence, mask-on time at effective pressure, was used as an interview probe and as a quantitative category to examine consistencies and differences in themes among adherers and nonadherers. A sequential qualitative-quantitative analysis plan was employed, using content analysis on text data to extract themes.;Results. Participants (n=15), predominantly male (87%), middle-aged (53.9+/-12.7years) and with severe OSA (Apnea-hypopnea index, 53.5+/-26.5events/hr) included African Americans (60%) and Caucasians (33%). Within-case and across-case analysis of interview data identify the unique experiences of being diagnosed with OSA and treated with CPAP were influenced by the perception of symptoms, perceived health risks, early exposure and experience with CPAP, and facilitators and barriers to seeking diagnosis and using CPAP. CPAP adherers and nonadherers, as well as married and unmarried participants, described different experiences relative to OSA and CPAP. There were no consistent differences in the described experiences between African American and Caucasian participants.;Conclusions. The critical nature of the individual's experience, from diagnosis through early treatment, as it influences treatment use, is consistent with recent theory-guided prediction studies. CPAP adherence interventions, based on profiles of nonadherers, are investigative opportunities extending from the exploratory findings of the study.