Damjanovic D, Fluck A, Bremer H, Müller-Quernheim J, Idzko M, Sorichter S
Dept of Pneumology, University Hospital Freiburg, Freiburg, Germany.
Eur Respir J. 2009 Apr;33(4):804-11. doi: 10.1183/09031936.00023408. Epub 2009 Jan 7.
Continuous positive airway pressure (CPAP) is an effective treatment for obstructive sleep apnoea syndrome (OSAS) but therapy adherence is often low. The hypothesis that CPAP-adherence and clinical outcomes can be improved by either using an autoadjusting-CPAP (APAP) device or an intensive support was tested. A controlled parallel group study was performed with 100 newly diagnosed OSAS patients, randomised into 4 groups (n = 25 each): standard or intensive support plus either APAP or CPAP. Intensive support included education and monthly home visits for 6 months. Clinical outcome was monitored by polysomnography at CPAP initiation and, after 3 and 9 months, compliance data were downloaded from the CPAP devices. After 9 months, intensively supported patients returned for follow-up in 88 versus 68% in the standard-support-group. Daily usage (mean+/-sem 5.7+/-0.2 for intensive support versus 4.6+/-0.4 h for standard support), percentage of days used (80.4+/-2.8 versus 57.0+/-5.9%) and proportion of individual sleep time (80.6+/-3.2 versus 64.9+/-6.2%) were also higher. There was no significant difference between APAP or CPAP, (daily usage 5.2+/-0.4 versus 5.1+/-0.3 h, percentage of days 67.9+/-5.0 versus 69.2+/-4.9%, proportion of sleep time 72.5+/-5.0% versus 72.1+/-5.2%, for APAP and CPAP) but retention rate was higher with CPAP. In summary, intensive support after continuous positive airway pressure initiation, rather than the application of autoadjusting-continuous positive airway pressure, increased therapy adherence.
持续气道正压通气（CPAP）是治疗阻塞性睡眠呼吸暂停综合征（OSAS）的一种有效方法，但治疗依从性往往较低。本研究对使用自动调压持续气道正压通气（APAP）设备或强化支持能否提高CPAP依从性及临床疗效这一假设进行了验证。对100例新诊断的OSAS患者进行了一项对照平行组研究，将其随机分为4组（每组n = 25）：标准支持或强化支持加APAP或CPAP。强化支持包括教育及为期6个月的每月一次家访。在开始使用CPAP时通过多导睡眠图监测临床疗效，3个月和9个月后，从CPAP设备下载依从性数据。9个月后，接受强化支持的患者复诊率为88%，而标准支持组为68%。每日使用时间（强化支持组平均±标准误为5.7±0.2小时，标准支持组为4.6±0.4小时）、使用天数百分比（80.4±2.8%对57.0±5.9%）和个体睡眠时间比例（80.6±3.2%对64.9±6.2%）在强化支持组也更高。APAP和CPAP之间无显著差异（每日使用时间分别为5.2±0.4小时和5.1±0.3小时，使用天数百分比分别为67.9±5.0%和69.2±4.9%，睡眠时间比例分别为72.5±5.0%和72.1±5.2%），但CPAP的保留率更高。总之，持续气道正压通气开始后的强化支持而非自动调压持续气道正压通气的应用提高了治疗依从性。
