McArdle N, Devereux G, Heidarnejad H, Engleman H M, Mackay T W, Douglas N J
Respiratory Medicine Unit, University of Edinburgh, Edinburgh, United Kingdom.
Am J Respir Crit Care Med. 1999 Apr;159(4 Pt 1):1108-14. doi: 10.1164/ajrccm.159.4.9807111.
Patients with the sleep apnea/hypopnea syndrome (SAHS) treated by nasal continuous positive airway pressure (CPAP) need to use CPAP long-term to prevent recurrence of symptoms. It is thus important to clarify the level of long-term CPAP use and the factors influencing long-term use. We examined determinants of objective CPAP use in 1, 211 consecutive patients with SAHS who were prescribed a CPAP trial between 1986 and 1997. Prospective CPAP use data were available in 1, 155 (95.4%), with a median follow-up of 22 mo (interquartile range [IQR], 12 to 36 mo). Fifty-two (4.5%) patients refused CPAP treatment (these were more often female and current smokers); 1,103 patients took CPAP home, and during follow-up 20% stopped treatment, primarily because of a lack of benefit. Methods of survival analysis showed that 68% of patients continued treatment at 5 yr. Independent predictors of long-term CPAP use were snoring history, apnea/hypopnea index (AHI), and Epworth score; 86% of patients with Epworth > 10 and an AHI >/= 30 were still using CPAP at 3 yr. Average nightly CPAP use within the first 3 mo was strongly predictive of long-term use. We conclude that long-term CPAP use is related to disease severity and subjective sleepiness and can be predicted within 3 mo.
经鼻持续气道正压通气（CPAP）治疗的睡眠呼吸暂停/低通气综合征（SAHS）患者需要长期使用CPAP以预防症状复发。因此，明确长期CPAP使用水平及影响长期使用的因素很重要。我们研究了1986年至1997年间连续1211例接受CPAP试验的SAHS患者客观CPAP使用的决定因素。1155例（95.4%）患者有前瞻性CPAP使用数据，中位随访时间为22个月（四分位间距[IQR]，12至36个月）。52例（4.5%）患者拒绝CPAP治疗（这些患者女性和当前吸烟者居多）；1103例患者将CPAP带回家，随访期间20%的患者停止治疗，主要原因是缺乏疗效。生存分析方法显示，68%的患者在5年时仍继续治疗。长期CPAP使用的独立预测因素为打鼾史、呼吸暂停/低通气指数（AHI）和爱泼华嗜睡量表评分；爱泼华嗜睡量表评分>10且AHI≥30的患者中，86%在3年时仍在使用CPAP。前3个月内每晚CPAP的平均使用时间对长期使用有很强的预测性。我们得出结论，长期CPAP使用与疾病严重程度和主观嗜睡有关，且在3个月内即可预测。
