Center of Sleep Disorder Medicine, Department of Respiratory Medicine, Tianjin Medical University General Hospital, No. 154 Anshan Road, Tianjin 300052, China.
Sleep Breath. 2013 May;17(2):791-801. doi: 10.1007/s11325-012-0766-3. Epub 2012 Sep 4.
The objective of the study was to evaluate the effectiveness of stage-matched intervention on adherence to continuous positive airway pressure (CPAP) in patients with obstructive sleep apnea syndrome.
One hundred and ten Chinese patients with newly diagnosed obstructive sleep apnea syndrome were enrolled in this study. They were randomly assigned into stage-matched care (SMC) and standard care (SC) groups (55 patients in each group). Patients in the SMC group received stage-matched intervention at different stages of behavior changes, and the SC group received only routine care. The intervention was based on the health action process approach theory and included risk perception, outcome expectancy, and self-efficacy. Questionnaires included the Self-Efficacy Measure for Sleep Apnea, the Epworth Sleepiness Scale (ESS), and the Pittsburgh Sleep Quality Index (PSQI). Data were collected at baseline and 1 and 3 months after home CPAP treatment, and hours of CPAP usage was also recorded at 1 and 3 months of follow-up.
At 1 month, CPAP usage was 5.59 ± 0.56 h/night (mean ± SD) vs 5.28 ± 0.67 h/night in the SMC and SC groups, respectively (p = 0.016). At 3 months, CPAP usage was 5.65 ± 0.50 vs 5.26 ± 0.82 h/night in the SMC and SC groups, respectively (p = 0.006). Repeated ANOVA analysis demonstrated that risk perception, outcome expectancy, and self-efficacy in the SMC group were significantly higher than those of the SC group (p < 0.05). Moreover, the time × group interaction was significant for outcome expectancy and self-efficacy, indicating that the groups differed significantly in changes in outcome expectancy and self-efficacy over the three time points. There was a significant difference between the SMC and SC groups in terms of improvement in ESS (p < 0.001) and PSQI (p = 0.013) after 3 months of CPAP treatment.
Stage-matched intervention could not only facilitate intention formation and enhance treatment self-efficacy but significantly improve CPAP adherence in OSA patients for the 3-month treatment.
本研究旨在评估阶段匹配干预对阻塞性睡眠呼吸暂停综合征（OSA）患者持续气道正压通气（CPAP）依从性的有效性。
本研究纳入了 110 例新诊断为 OSA 的中国患者，将其随机分为阶段匹配护理（SMC）组和标准护理（SC）组（每组 55 例）。SMC 组患者在行为改变的不同阶段接受阶段匹配干预，而 SC 组仅接受常规护理。干预基于健康行动过程方法理论，包括风险感知、结果预期和自我效能。调查问卷包括睡眠呼吸暂停自我效能量表、Epworth 嗜睡量表（ESS）和匹兹堡睡眠质量指数（PSQI）。在家庭 CPAP 治疗后 1 个月和 3 个月收集数据，并在随访 1 个月和 3 个月时记录 CPAP 使用时间。
1 个月时，SMC 组和 SC 组的 CPAP 使用时间分别为 5.59±0.56 小时/夜和 5.28±0.67 小时/夜（p=0.016）。3 个月时，SMC 组和 SC 组的 CPAP 使用时间分别为 5.65±0.50 小时/夜和 5.26±0.82 小时/夜（p=0.006）。重复方差分析表明，SMC 组的风险感知、结果预期和自我效能均显著高于 SC 组（p<0.05）。此外，结果预期和自我效能的组间时间交互作用显著，表明两组在三个时间点的结果预期和自我效能变化上存在显著差异。SMC 组和 SC 组在 CPAP 治疗 3 个月后的 ESS（p<0.001）和 PSQI（p=0.013）改善方面存在显著差异。
阶段匹配干预不仅可以促进意向形成，增强治疗自我效能，还可以显著提高 OSA 患者 3 个月 CPAP 治疗的依从性。
