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Original Research: SLEEP MEDICINE |

Adherence to Sleep Apnea Therapy and Use of Lipid-Lowering Drugs: A Study of the Healthy-User Effect

Alec B. Platt, MD, MSCE; Samuel T. Kuna, MD; Samuel H. Field, PhD; Zhen Chen, PhD; Rajesh Gupta, BS; Dominic F. Roche, AS; Jason D. Christie, MD, MS; David A. Asch, MD, MBA; Writing Group for the Women’s Health Initiative Investigators
Author and Funding Information

From the Center for Health Equity Research and Promotion (Drs Platt, Kuna, Field, and Asch, and Mr Roche), and the Pulmonary, Critical Care and Sleep Section (Mr Gupta), Philadelphia Veterans Affairs Medical Center, Philadelphia, PA; the Department of Medicine (Drs Kuna, Christie, and Asch), and the Center for Clinical Epidemiology and Biostatistics (Drs Christie and Asch), University of Pennsylvania School of Medicine, Philadelphia, PA; The Reading Hospital and Medical Center (Dr Platt), Reading, PA; the FPG Child Development Institute (Dr Field), University of North Carolina, Chapel Hill, NC; and the Division of Epidemiology, Statistics, and Prevention Research (Dr Chen), National Institute of Child Health and Development, Rockville, MD.

Correspondence to: Alec B. Platt, MD, MSCE, 2608 Keiser Blvd., Wyomissing, PA 19610; e-mail: alecplatt@gmail.com


Funding/Support: This study was supported by grant funding to Dr Platt from Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, Philadelphia, PA. Dr Platt was supported by a training grant from National Institutes of Health [Grant T-32 HL07713-14].

Dr Platt presented the results from this paper in abstract form on June 9, 2008, at the 22nd Annual Meeting of the Associated Professional Sleep Societies, Baltimore, MD.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;137(1):102-108. doi:10.1378/chest.09-0842
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Background:  Evidence that continuous positive airway pressure (CPAP) reduces cardiovascular morbidity comes largely from observational studies. This association may be confounded if CPAP adherents are healthier in ways not measured by investigators. We assessed whether patients adhering to lipid-lowering medications were more adherent to CPAP.

Methods:  This was a retrospective cohort study undertaken at the Philadelphia Veterans Affairs (VA) Medical Center (2005-2006) of consecutive patients on lipid-lowering therapy newly initiating CPAP for obstructive sleep apnea. Adherence to medications dispensed via the VA closed-pharmacy system was measured as the proportion of days covered (≥80% vs < 80%) in the year prior to CPAP initiation. CPAP adherence was defined as ≥ 4 h/d of “mask-on” time, measured electronically daily during the first week of CPAP. We examined the association between medication adherence and CPAP adherence using multivariable logistic regression.

Results:  Complete data were available for 117 of 142 (81.5%) subjects. After adjustment for age, race, medical comorbidity, and sleep apnea-related clinical factors, subjects with low medication adherence demonstrated a 40.1% (95% CI, 30.0-51.0) probability of using CPAP ≥ 4 h/d compared with 55.2% (95% CI, 46.9-63.1) for subjects with adequate (≥80%) medication adherence (adjusted for comparison, odds ratio (OR) = 1.8 [95% CI, 1.0-3.3], P = .04). Married patients were more adherent to medications and CPAP; inclusion of this factor reduced to nonsignificance the association of medication and CPAP adherence (OR = 1.6 [95% CI, 0.9-2.8], P = .12).

Conclusion:  Patients consistently refilling lipid-lowering medications were more adherent to CPAP, suggesting that differences in medication adherence or other health-promoting behaviors should be investigated in future nonrandomized, observational studies linking CPAP adherence and cardiovascular outcomes.

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