D

Patient D was a 40-year-old African American woman whose living situation involved unstable and economically impoverished conditions. She had not finished high school, and her stroke deficits compounded her inability to find employment. She lived with three daughters, various house guests, and grandchildren; they resided in three different locations during the 12-month study period.

Her home during the initial sleep study was a two-story rental house located in a high-crime neighborhood. The living room had two sofas and a love seat. During the first staff visit, Patient D's daughter was asleep on one of the sofas and a man was asleep on another. The patient slept and spent most of her waking hours on the third. The hardwood floors were covered in cigarette ash, fast food bags and cups, and plastic bags filled with clothing. Thewindow in the living room was broken and covered with shredded plastic that allowed outside air to blow into the room.

The patient had a history of noncompliance with prescribed medications. For example, study staff learned that she had not been taking her hypertension medications, reportedly due to cost. As a consequence, Patient D often had elevated blood pressure during her participation in the study. 

Patient D's initial sleep study was difficult to perform due to her inability to sit for long periods of time. The patient removed the equipment before bedtime, resulting in a failed study. However, she was willing to try again and the second time the study was successfully completed with the exception that she refused to allow the placement of some of the leads and pulled off others before falling