The purpose of this research is to compare the impact of motivational enhancement therapy (MET), delivered by culturally congruent community health care workers (CHWs) versus usual care patients with previously untreated moderate-to-severe obstructive sleep apnea (OSA) on adherence to positive airway pressure (PAP) therapy.

Inclusion Criteria

• ≥ 18 years of age
• Moderate-to-severe OSA
• Available to attend study visits and sessions
• Reliable access to a phone

Exclusion Criteria

• Prior or current use of PAP therapy or other treatment (e.g., oral appliance) for OSA
• History of upper airway surgery for OSA
• Moderate to severe insomnia
• Commercial drivers
• Use of non-standard PAP including adaptive servo-ventilation or bi-level positive airway pressure
• Report of motor vehicle accident or near-miss due to sleepiness within the 2 previous years
• Unstable medical conditions that may preclude enrollment in the protocol such as: uncontrolled angina and/or congestive heart failure, uncontrolled blood pressure or resistant hypertension, severe chronic obstructive pulmonary disease, cancer, and active psychiatric disease (e.g., major depression)
• Other sleep disorders (e.g., circadian rhythm disorder)
• Use of supplemental oxygen during wakefulness or sleep
• Central sleep apnea, obesity hypoventilation syndrome or Cheyne-Stokes respiration based on the home sleep apnea test
• Resting awake oxygen saturation (SpO2) < 90%
• Participation in another clinical trial