Wells Rachel D, Freedland Kenneth E, Carney Robert M, Duntley Stephen P, Stepanski Edward J
Behavioral Medicine Institute, St. Louis, MO 63110, USA.
Psychosom Med. 2007 Jun;69(5):449-54. doi: 10.1097/psy.0b013e318068b2f7. Epub 2007 Jun 7.
To examine if reported obstructive sleep apnea (OSA) symptom improvement, baseline depressive symptoms, or polysomnographically measured sleep parameters are associated with adherence to continuous positive airway pressure (CPAP). CPAP is a highly effective treatment for OSA. Low adherence to CPAP therapy is common and poorly understood. Depression and lack of perceived benefits from CPAP are possible reasons for low adherence.
Seventy-eight patients evaluated for OSA at a sleep medicine center agreed to participate in the study; 54 patients completed all study assessments. The Beck Depression Inventory (BDI) and the functional outcomes of sleep questionnaire (FOSQ) were administered before polysomnographic evaluation. A card embedded in the CPAP device electronically recorded adherence. The BDI and FOSQ were administered 1 to 2 months after the baseline measurements were obtained.
Baseline depressive symptoms were not correlated with mean duration of CPAP use per night. Reported improvements in OSA symptoms were correlated positively with CPAP adherence. There were significant positive correlations between improvement in depressive symptoms and OSA symptoms after initiation of CPAP therapy. The polysomnographic variables measured did not predict improvement in daytime OSA symptoms or CPAP adherence. Post hoc analyses suggested that those individuals with baseline Apnea Hypopnea Index (AHI) between 40 and 80 experienced more symptom improvement than those with AHI <40 or >80.
Patients with the greatest level of CPAP adherence also reported the greatest improvement in OSA symptoms. Patients who continued to experience OSA symptoms after CPAP treatment also tended to have more depressive symptoms after CPAP treatment.
探讨报告的阻塞性睡眠呼吸暂停（OSA）症状改善情况、基线抑郁症状或多导睡眠图测量的睡眠参数是否与持续气道正压通气（CPAP）的依从性相关。CPAP是治疗OSA的一种高效疗法。CPAP治疗的低依从性很常见且了解不足。抑郁以及感觉不到CPAP的益处可能是依从性低的原因。
一家睡眠医学中心对78名接受OSA评估的患者同意参与本研究；54名患者完成了所有研究评估。在多导睡眠图评估前使用贝克抑郁量表（BDI）和睡眠问卷功能结果量表（FOSQ）。CPAP设备中嵌入的一张卡片以电子方式记录依从性。在获得基线测量值1至2个月后再次使用BDI和FOSQ。
基线抑郁症状与每晚CPAP使用的平均时长不相关。报告的OSA症状改善与CPAP依从性呈正相关。CPAP治疗开始后，抑郁症状改善与OSA症状改善之间存在显著正相关。所测量的多导睡眠图变量无法预测日间OSA症状的改善或CPAP依从性。事后分析表明，基线呼吸暂停低通气指数（AHI）在40至80之间的个体比AHI<40或>80的个体症状改善更多。
CPAP依从性最高的患者报告的OSA症状改善也最大。CPAP治疗后仍有OSA症状的患者在CPAP治疗后也往往有更多抑郁症状。
