Objectives: Few minority patients with sleep apnea have been evaluated or treated. This study ascertained adherence rate to referrals for sleep apnea evaluation by primary care physicians in a community-based sample of black patients; it also examined baseline characteristics likely to influence adherence rates.
Methods: A retrospective chart audit was conducted at a hospital-based sleep clinic. Scrutiny was limited to male and female patients between the ages of 20 and 80 years. Data obtained for this analysis included baseline characteristics from a detailed sleep history and/or screening questionnaires and polysomnographic parameters.
Results: Of the 421 patients referred by their private care physicians, 38% (n=160) adhered to the recommendation for a sleep consultation, but all who showed up for their appointment underwent polysomnographic studies. Logistic regression analyses showed that obesity and daytime sleepiness were the most important factors predicting adherence, with multivariate-adjusted odds ratios of 2.69 [95% CI: 1.54-4.71, p < 0.001] and 6.98 [95% CI: 3.86-12.64, p < 0.001], respectively. Of the patients who underwent a polysomnographic sleep evaluation, 91% received a sleep apnea diagnosis and were treated.
Conclusions: Black patients may be underutilizing available sleep services, but direct comparisons with other ethnic groups could not be made because of insufficient archival data. While the present study does not identify specific barriers to accessing services for sleep problems, it indicates that blacks who are obese and/or are experiencing daytime sleepiness are likely to adhere to recommendations of their physician. Targeted culturally congruent educational interventions to increase awareness of sleep apnea in black communities might help to increase adherence rate.