Secció de Pneumologia, Hospital Universitari Sant Joan d'Alacant, Ctra. Alacant-València s/n. CP 03550, Sant Joan d'Alacant, Spain.
Eur Respir J. 2012 Feb;39(2):305-12. doi: 10.1183/09031936.00013311. Epub 2011 Jun 30.
The aim of this study to evaluate the efficacy of a home-based programme on clinical response, continuous positive airway pressure (CPAP) compliance and cost in a population of high pre-test probability of suffering obstructive sleep apnoea syndrome (OSAS). Patients were randomised into the following three groups. Group A: home respiratory polygraphy (RP) and home follow-up; group B: hospital polysomnography and hospital follow-up; and group C: home RP and hospital follow-up. Evaluation during 6 months included Epworth Sleepiness Scale (ESS), Functional Outcomes Sleep Questionnaire (FOSQ), and daily activity and symptom questionnaires. Compliance was assessed by memory cards (group A) and using an hourly counter (groups B and C). 66 patients were included (22 per branch), 83% were males, aged mean±sd 52±10 yrs, body mass index 34±7kg·m(-2), apnoea/hypopnoea index 43±20 h(-1), CPAP pressure 8±2 cmH(2)O, with no between-group differences. Clinical response showed an ESS of mean±sd 15±3 to 6±4, a FOSQ of 16±3 to 18±2, symptoms of 43±7 to 25±7, and activity of 37±11 to 25±8. At the end of the study, compliance was: group A 73%, group B 68% and group C 57%. The cost per patient was: group A €590±43, group B €894±11 and group C €644±93 (p<0.001). In conclusion, patients with a high initial probability of having OSAS can be diagnosed and treated in a home setting, with a high level of CPAP compliance and lower cost than using either a hospital-based approach or home RP/hospital follow-up.
本研究旨在评估家庭为基础的方案在临床反应、持续气道正压通气（CPAP）顺应性和成本方面的疗效，用于高初筛阻塞性睡眠呼吸暂停综合征（OSAS）概率的人群。患者被随机分为以下三组。A 组：家庭呼吸多导睡眠图（RP）和家庭随访；B 组：医院多导睡眠图和医院随访；C 组：家庭 RP 和医院随访。6 个月的评估包括 Epworth 嗜睡量表（ESS）、功能结局睡眠问卷（FOSQ）以及日常活动和症状问卷。A 组通过记忆卡评估顺应性，B 组和 C 组则使用小时计数器。共纳入 66 例患者（每组 22 例），83%为男性，年龄均数±标准差为 52±10 岁，体重指数为 34±7kg·m(-2)，呼吸暂停/低通气指数为 43±20 h(-1)，CPAP 压力为 8±2cmH(2)O，组间无差异。临床反应表现为 ESS 由均数±标准差 15±3 降至 6±4，FOSQ 由 16±3 升至 18±2，症状由 43±7 降至 25±7，活动由 37±11 降至 25±8。研究结束时，A 组顺应性为 73%，B 组为 68%，C 组为 57%。每位患者的费用为：A 组 590±43 欧元，B 组 894±11 欧元，C 组 644±93 欧元（p<0.001）。结论：对于 OSAS 初筛概率高的患者，可在家庭环境中进行诊断和治疗，CPAP 顺应性高，成本低于医院为基础的方法或家庭 RP/医院随访。
