Clinic for Pneumology, Cardiology, Allergology, Sleep Medicine and Respiratory Care, Krankenhaus der Augustinerinnen, Cologne, Germany.
Respiration. 2011;82(2):155-61. doi: 10.1159/000322838. Epub 2011 Mar 4.
Long-term adherence to positive airway pressure (PAP) treatment is essential in patients with obstructive sleep apnea syndrome (OSAS).
The aim of the present study was to analyze treatment adherence under real-life conditions and factors associated with discontinuation of PAP therapy.
Patients newly diagnosed with OSAS and started on PAP therapy were contacted by telephone after a minimum of 1 year. Side effects, quality of life, subjective treatment adherence and Epworth Sleepiness Scale (ESS) scores were assessed. Objective treatment adherence was calculated by reading the built-in run time counter of the PAP device. Anthropometric parameters, level of education, apnea-hypopnea index (AHI), ESS score and the type of PAP therapy prescribed at the time of the first stay in the sleep lab were collected retrospectively.
Median follow-up was 13 months (range 7-18 months). Of 303 patients (69 female, 234 male) available for this study, 191 patients (63%) still used the PAP device regularly ('users'), while 83 (27.4%) had definitively discontinued PAP treatment ('nonusers'). In the nonusers group, 29 patients (34.9%) discontinued PAP treatment within the first 3 months. In the users group, subjective PAP usage was 6.6 ± 1.5 h/night and objective adherence was 4.7 ± 2.3 h/night. Objective nightly use of PAP treatment correlated significantly with baseline AHI (r = 0.13, p = 0.041) but not with sex, age, body mass index, ESS score or education level. Patients with a low AHI and ESS score and patients without a coexisting medical condition or with more than two comorbidities tended to discontinue PAP therapy more frequently.
PAP treatment adherence has to be optimized in OSAS patients. When initiating PAP therapy, clinicians have to focus on those patients at risk for discontinuing treatment. Education sessions and closer follow-up are possible strategies to improve treatment adherence and to avoid treatment discontinuation.
长期坚持使用正压通气（PAP）治疗对阻塞性睡眠呼吸暂停综合征（OSAS）患者至关重要。
本研究旨在分析现实生活条件下的治疗依从性，并分析与 PAP 治疗中断相关的因素。
对至少接受 1 年 PAP 治疗的新诊断为 OSAS 且开始接受 PAP 治疗的患者进行电话随访。评估副作用、生活质量、主观治疗依从性和 Epworth 睡眠量表（ESS）评分。通过读取 PAP 设备内置的运行时间计数器来计算客观治疗依从性。回顾性收集首次入住睡眠实验室时的人体测量参数、教育程度、呼吸暂停低通气指数（AHI）、ESS 评分和所开 PAP 治疗类型等数据。
中位随访时间为 13 个月（7-18 个月）。本研究共纳入 303 例患者（69 例女性，234 例男性），191 例（63%）患者仍定期使用 PAP 设备（“使用者”），83 例（27.4%）患者已停止 PAP 治疗（“非使用者”）。在非使用者组中，29 例（34.9%）在治疗的前 3 个月内停止使用 PAP 治疗。在使用者组中，主观 PAP 使用时间为 6.6±1.5 h/夜，客观依从性为 4.7±2.3 h/夜。客观夜间 PAP 治疗使用率与基线 AHI 显著相关（r=0.13，p=0.041），但与性别、年龄、体重指数、ESS 评分或教育程度无关。AHI 和 ESS 评分较低、无合并症或合并两种以上合并症的患者更倾向于停止 PAP 治疗。
必须优化 OSAS 患者的 PAP 治疗依从性。启动 PAP 治疗时，临床医生必须关注那些有停药风险的患者。教育课程和更密切的随访是提高治疗依从性和避免治疗中断的可能策略。
