Acceptability, adaptability and adherence to CPAP therapy among Aboriginal Australians with OSA - “The A5 study”: CPAP adherence among Aboriginal Australians

Subash S. Heraganahally; Timothy Paul Howarth; Ara J. Perez; Jessie  Crespo; Charmain  Atos; Brian J. Cluney; Linda Ford

doi:10.1016/j.sleep.2022.12.024

Acceptability, adaptability and adherence to CPAP therapy among Aboriginal Australians with OSA - “The A5 study”: CPAP adherence among Aboriginal Australians

Subash S. Heraganahally (Corresponding Author), Timothy Paul Howarth, Ara J. Perez, Jessie Crespo, Charmain Atos , Brian J. Cluney, Linda Ford

Research output: Contribution to journal › Article › peer-review

3 Citations (Scopus)

Abstract

Background: Studies examining how Australian Aboriginal people will accept, adapt and adhere to interventions such as continuous positive airway pressure (CPAP) therapy in the management of obstructive sleep apnoea (OSA) are sparsely reported. Methods: In this study, clinical, demographic, polysomnographic (PSG) and CPAP data were utilised to assess and predict acceptance and adherence to CPAP therapy among adult Aboriginal Australians diagnosed to have OSA. Results: Of the 649 Aboriginal patients with OSA, 49% accepted to trial CPAP therapy. Patients who accepted to trial CPAP showed more severe OSA (65vs.35% with severe OSA), reported higher daytime sleepiness (median 10vs.9), and had a higher BMI (83vs.73% obese). Of those who accepted to trial CPAP, 62% adapted to therapy (used the device for more than 30 days). Patients who adapted had more severe OSA (71vs.54% with severe OSA), and were more likely to live in urban areas (63vs.40%). Of those who adapted, 32% were adherent to therapy. Adherent patients were more likely to live in urban areas (84vs.53%), though there was no difference in OSA severity between adherent and non-adherent patients. In multivariate models remote location and more severe OSA predicted CPAP acceptance, while urban location and more severe OSA predicted adaptation, and urban location and higher oxygen saturation nadir predicted adherence. Conclusions: Acceptance to trial CPAP therapy was observed in the presence of symptomatic and severe OSA. However, long term adherence to CPAP therapy was significantly influenced by patients’ residential location, with patients residing in remote/rural settings demonstrating significantly lower adherence rates.

Original language	English
Pages (from-to)	147-156
Number of pages	10
Journal	Sleep Medicine
Volume	102
DOIs	https://doi.org/10.1016/j.sleep.2022.12.024
Publication status	Published - Feb 2023

Bibliographical note

Funding Information:
We would like to thank our respiratory clinical nurse consultants, Mrs Raelene Messenger and Mrs Siji Issac from the respiratory chronic disease unit, at the RDH, including, rural and remote community Aboriginal health workers and RDH patients travel division for co-ordinating care for Aboriginal people living in the remote and rural communities with sleep disorders. We also would like to thank all the sleep technologists at DRSH/DPH in conducting diagnostic and PAP implementation studies, including traveling to remote Aboriginal communities to conduct ambulatory and PAP implementation studies during respiratory and sleep outreach visits.

Publisher Copyright:
© 2023 Elsevier B.V.

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10.1016/j.sleep.2022.12.024

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@article{f585c5231d4043b294bd918f754b9fc3,

title = "Acceptability, adaptability and adherence to CPAP therapy among Aboriginal Australians with OSA - “The A5 study”: CPAP adherence among Aboriginal Australians",

abstract = "Background: Studies examining how Australian Aboriginal people will accept, adapt and adhere to interventions such as continuous positive airway pressure (CPAP) therapy in the management of obstructive sleep apnoea (OSA) are sparsely reported. Methods: In this study, clinical, demographic, polysomnographic (PSG) and CPAP data were utilised to assess and predict acceptance and adherence to CPAP therapy among adult Aboriginal Australians diagnosed to have OSA. Results: Of the 649 Aboriginal patients with OSA, 49% accepted to trial CPAP therapy. Patients who accepted to trial CPAP showed more severe OSA (65vs.35% with severe OSA), reported higher daytime sleepiness (median 10vs.9), and had a higher BMI (83vs.73% obese). Of those who accepted to trial CPAP, 62% adapted to therapy (used the device for more than 30 days). Patients who adapted had more severe OSA (71vs.54% with severe OSA), and were more likely to live in urban areas (63vs.40%). Of those who adapted, 32% were adherent to therapy. Adherent patients were more likely to live in urban areas (84vs.53%), though there was no difference in OSA severity between adherent and non-adherent patients. In multivariate models remote location and more severe OSA predicted CPAP acceptance, while urban location and more severe OSA predicted adaptation, and urban location and higher oxygen saturation nadir predicted adherence. Conclusions: Acceptance to trial CPAP therapy was observed in the presence of symptomatic and severe OSA. However, long term adherence to CPAP therapy was significantly influenced by patients{\textquoteright} residential location, with patients residing in remote/rural settings demonstrating significantly lower adherence rates.",

keywords = "Aboriginal, First nations, Indigenous, Polysomnography, Sleep apnoea, Sleep study",

author = "Heraganahally, {Subash S.} and Howarth, {Timothy Paul} and Perez, {Ara J.} and Jessie Crespo and Charmain Atos and Cluney, {Brian J.} and Linda Ford",

note = "Funding Information: We would like to thank our respiratory clinical nurse consultants, Mrs Raelene Messenger and Mrs Siji Issac from the respiratory chronic disease unit, at the RDH, including, rural and remote community Aboriginal health workers and RDH patients travel division for co-ordinating care for Aboriginal people living in the remote and rural communities with sleep disorders. We also would like to thank all the sleep technologists at DRSH/DPH in conducting diagnostic and PAP implementation studies, including traveling to remote Aboriginal communities to conduct ambulatory and PAP implementation studies during respiratory and sleep outreach visits. Publisher Copyright: {\textcopyright} 2023 Elsevier B.V.",

year = "2023",

month = feb,

doi = "10.1016/j.sleep.2022.12.024",

language = "English",

volume = "102",

pages = "147--156",

journal = "Sleep Medicine",

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Acceptability, adaptability and adherence to CPAP therapy among Aboriginal Australians with OSA - “The A5 study”: CPAP adherence among Aboriginal Australians. / Heraganahally, Subash S. (Corresponding Author); Howarth, Timothy Paul; Perez, Ara J. et al.
In: Sleep Medicine, Vol. 102, 02.2023, p. 147-156.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Acceptability, adaptability and adherence to CPAP therapy among Aboriginal Australians with OSA - “The A5 study”

T2 - CPAP adherence among Aboriginal Australians

AU - Heraganahally, Subash S.

AU - Howarth, Timothy Paul

AU - Perez, Ara J.

AU - Crespo, Jessie

AU - Atos , Charmain

AU - Cluney, Brian J.

AU - Ford, Linda

N1 - Funding Information: We would like to thank our respiratory clinical nurse consultants, Mrs Raelene Messenger and Mrs Siji Issac from the respiratory chronic disease unit, at the RDH, including, rural and remote community Aboriginal health workers and RDH patients travel division for co-ordinating care for Aboriginal people living in the remote and rural communities with sleep disorders. We also would like to thank all the sleep technologists at DRSH/DPH in conducting diagnostic and PAP implementation studies, including traveling to remote Aboriginal communities to conduct ambulatory and PAP implementation studies during respiratory and sleep outreach visits. Publisher Copyright: © 2023 Elsevier B.V.

PY - 2023/2

Y1 - 2023/2

N2 - Background: Studies examining how Australian Aboriginal people will accept, adapt and adhere to interventions such as continuous positive airway pressure (CPAP) therapy in the management of obstructive sleep apnoea (OSA) are sparsely reported. Methods: In this study, clinical, demographic, polysomnographic (PSG) and CPAP data were utilised to assess and predict acceptance and adherence to CPAP therapy among adult Aboriginal Australians diagnosed to have OSA. Results: Of the 649 Aboriginal patients with OSA, 49% accepted to trial CPAP therapy. Patients who accepted to trial CPAP showed more severe OSA (65vs.35% with severe OSA), reported higher daytime sleepiness (median 10vs.9), and had a higher BMI (83vs.73% obese). Of those who accepted to trial CPAP, 62% adapted to therapy (used the device for more than 30 days). Patients who adapted had more severe OSA (71vs.54% with severe OSA), and were more likely to live in urban areas (63vs.40%). Of those who adapted, 32% were adherent to therapy. Adherent patients were more likely to live in urban areas (84vs.53%), though there was no difference in OSA severity between adherent and non-adherent patients. In multivariate models remote location and more severe OSA predicted CPAP acceptance, while urban location and more severe OSA predicted adaptation, and urban location and higher oxygen saturation nadir predicted adherence. Conclusions: Acceptance to trial CPAP therapy was observed in the presence of symptomatic and severe OSA. However, long term adherence to CPAP therapy was significantly influenced by patients’ residential location, with patients residing in remote/rural settings demonstrating significantly lower adherence rates.

AB - Background: Studies examining how Australian Aboriginal people will accept, adapt and adhere to interventions such as continuous positive airway pressure (CPAP) therapy in the management of obstructive sleep apnoea (OSA) are sparsely reported. Methods: In this study, clinical, demographic, polysomnographic (PSG) and CPAP data were utilised to assess and predict acceptance and adherence to CPAP therapy among adult Aboriginal Australians diagnosed to have OSA. Results: Of the 649 Aboriginal patients with OSA, 49% accepted to trial CPAP therapy. Patients who accepted to trial CPAP showed more severe OSA (65vs.35% with severe OSA), reported higher daytime sleepiness (median 10vs.9), and had a higher BMI (83vs.73% obese). Of those who accepted to trial CPAP, 62% adapted to therapy (used the device for more than 30 days). Patients who adapted had more severe OSA (71vs.54% with severe OSA), and were more likely to live in urban areas (63vs.40%). Of those who adapted, 32% were adherent to therapy. Adherent patients were more likely to live in urban areas (84vs.53%), though there was no difference in OSA severity between adherent and non-adherent patients. In multivariate models remote location and more severe OSA predicted CPAP acceptance, while urban location and more severe OSA predicted adaptation, and urban location and higher oxygen saturation nadir predicted adherence. Conclusions: Acceptance to trial CPAP therapy was observed in the presence of symptomatic and severe OSA. However, long term adherence to CPAP therapy was significantly influenced by patients’ residential location, with patients residing in remote/rural settings demonstrating significantly lower adherence rates.

KW - Aboriginal

KW - First nations

KW - Indigenous

KW - Polysomnography

KW - Sleep apnoea

KW - Sleep study

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U2 - 10.1016/j.sleep.2022.12.024

DO - 10.1016/j.sleep.2022.12.024

M3 - Article

SN - 1389-9457

VL - 102

SP - 147

EP - 156

JO - Sleep Medicine

JF - Sleep Medicine

ER -

Acceptability, adaptability and adherence to CPAP therapy among Aboriginal Australians with OSA - “The A5 study”: CPAP adherence among Aboriginal Australians

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