Predictors of Adherence to Continuous Positive Airway Pressure in Older Adults With Apnea and Amnestic Mild Cognitive Impairment.

BACKGROUND: Almost 60% of adults with amnestic mild cognitive impairment (aMCI) have obstructive sleep apnea (OSA). Treatment with continuous positive airway pressure (CPAP) may delay cognitive decline, but CPAP adherence is often suboptimal. In this study, we report predictors of CPAP adherence in older adults with aMCI who have increased odds of progressing to dementia, particularly due to Alzheimer's disease. METHODS: The data are from Memories 2, "Changing the Trajectory of Mild Cognitive Impairment with CPAP Treatment of Obstructive Sleep Apnea." Participants had moderate to severe OSA, were CPAP naïve, and received a telehealth CPAP adherence intervention. Linear and logistic regression models examined predictors. RESULTS: The 174 participants (mean age 67.08 years, 80 female, 38 Black persons) had a mean apnea-hypopnea index of 34.78, and 73.6% were adherent, defined as an average of ≥4 hours of CPAP use per night. Only 18 (47.4%) Black persons were CPAP adherent. In linear models, White race, moderate OSA, and participation in the tailored CPAP adherence intervention were significantly associated with higher CPAP use at 3 months. In logistic models, White persons had 9.94 times the odds of adhering to CPAP compared to Black persons. Age, sex, ethnicity, education, body mass index, nighttime sleep duration, daytime sleepiness, and cognitive status were not significant predictors. CONCLUSIONS: Older patients with aMCI have high CPAP adherence, suggesting that age and cognitive impairment should not be a barrier to prescribing CPAP. Research is needed to improve adherence in Black patients, perhaps through culturally tailored interventions.

Implications of Social Determinants of Health Characteristics on Fetal Growth Restriction Among Various Racial/Ethnic Groups.

OBJECTIVES: Current knowledge regarding the relationship between social determinants of health (SDOH) characteristics of hospitalized American pregnant women and fetal growth restriction (FGR) reveals a dearth in the literature. Therefore, we examined the impact of SDOH on FGR among hospitalized American women in this study. METHODS: Using the Nationwide Inpatient Sample (NIS) dataset for the years 2016-2018, we conducted this cross-sectional study. We conducted survey logistic regression to examine the association between SDOH factors and FGR, after adjusting for various hospitalization characteristics. RESULTS: Non-Hispanic (NH)-Black people had the highest prevalence of SDOH issues (0.7%), followed by Hispanics who had a prevalence of 0.4%. We observed that pregnant women with SDOH issues were 1.16 times as likely to experience FGR as those without SDOH (95% CI 1.0-1.34). When compared to their respective racial counterparts without SDOH, Hispanics with SDOH had increased odds, NH-White and NH-others with SDOH had the same likelihood, and NH-Black women with SDOH had lower odds of FGR. CONCLUSIONS FOR PRACTICE: Overall, our study illustrated an association between maternal SDOH issues and FGR, and the impact of SDOH issues on the outcome of FGR across various racial/ethnic groups. While our study provides useful insight into the topic, further research is needed to explain the observed varied influence of SDOH on FGR across racial/ethnic groups.

What is already known on this subject? Children with fetal growth restriction (FGR) present with a greater risk of long-term health effects including impaired neurological, cardiovascular and endocrine diseases in adulthood. FGR affects 5-10% of pregnancies and is the second leading cause of perinatal mortality.What this study adds? An association between maternal social determinants of health (SDOH) issues and FGR, and the impact of SDOH issues on the outcome of FGR across various racial/ethnic groups is present. When compared to their respective racial counterparts without SDOH, Hispanics with SDOH had increased odds of FGR.