LAUSR

The Self-Efficacy Measure for Sleep Apnea (SEMSA) is a self-administered questionnaire developed to assess pretreatment expectancies between obstructive sleep apnea (OSA) and continuous positive airway pressure (CPAP) therapy in adults. Higher values on the three sub-scales of the SEMSA suggest a greater perceived risk of having OSA, more positive beliefs regarding the outcomes of CPAP therapy, and a greater willingness to use CPAP. We examined the utility of the SEMSA in predicting CPAP adherence in a diverse urban population. SEMSA was completed by patients presenting for polysomnography (PSG) over three months. We collected demographic data, body mass index (BMI), marital status, social vulnerability index (SVI), apnea hypopnea index (AHI), and 30-day adherence data from CPAP device download following the initiation of therapy. The outcomes were CPAP average usage per day in the first 30 days (minutes) and the percentage of days with usage over 4 hours. Stata v15 was used for multivariable linear and logistic regression analyses. One hundred eighty-eight patients completed the SEMSA, of which 101 were diagnosed with OSA and initiated CPAP. The study sample was middle-aged (mean ± SD, 52.5±13.3 years), with variable OSA severity (AHI 44.8±39.5) and high levels of obesity (BMI 39.5±12.4) and racial diversity (61% Black, 10% White, 18% Hispanic, and 10% other), 47% were men, and 33% were married. The multivariable models found that after adjusting for age, sex, race, marital status, SVI, ESS, and AHI, the SEMSA score was a significant predictor of average CPAP use (linear regression, t-statistic=3.19, p=0.002) and ≥70% CPAP use of ≥4 hours per day (logistic regression, t-statistic=3.23, p=0.002, area under the curve; AUC=0.73). The SEMSA score is a strong predictor of CPAP adherence in a diverse urban population. The patients with lower self-efficacy based on the SEMSA should be targeted for early CPAP adherence promoting education and interventions.