Schoch Otto D, Baty Florent, Niedermann Jolanda, Rüdiger Jochen J, Brutsche Martin H
Division of Pneumology and Multidisciplinary Center for Sleep Medicine, Kantonsspital St. Gallen, St.Gallen, Switzerland.
Respiration. 2014;87(2):121-8. doi: 10.1159/000354186. Epub 2013 Nov 5.
Positive airway pressure (PAP) therapy is the standard treatment for obstructive sleep apnea syndrome (OSAS).
The aim of the current study was to determine operational long-term adherence to PAP and its predictors.
In a retrospective single-center observational cohort study, we analyzed all patients referred to our center with suspected OSAS between November 2001 and November 2011. Baseline results and last follow-up data of each patient were analyzed. Kaplan-Meier estimates of adherence and Cox proportional hazard regression for age, gender, Epworth sleepiness scale (ESS) scores, body mass index, apnea-hypopnea index (AHI) and oxygen desaturation index (ODI) were performed. Evolution of adherence was analyzed in yearly cohorts comparing the proportion of patients discontinuing PAP within 6 and 12 months.
Of 4,638 referrals, 2,187 confirmed OSAS patients started PAP, 297 (14%) were referred out to other centers to follow-up, 42 (2%) died, and 92 (5%) no longer needed PAP. Of 1,756 patients, the median follow-up was 36 months [95% confidence interval (CI) 33.6-37.8], and adherence at 1, 5 and 10 years was 74 (CI 71-75; n = 1,028), 55 (CI 53-58; n = 281) and 51% (CI 48-55; n = 10), respectively. Adherence is associated with ESS score [hazard ratio (HR) 0.60; CI 0.47-0.78], ODI (HR 0.50; CI 0.32-0.77) and AHI (HR 0.56; CI 0.37-0.85). In yearly cohorts according to inclusion date, the absconder rate at 6 and 12 months was 20 (CI 18-22) and 27% (CI 25-30) for the first 8 years and improved to 10 (CI 7-15) and 14% (CI 10-19) for the last 2 years, respectively.
Long-term adherence to PAP in OSAS is associated with baseline measures of disease severity. After 2009, an improvement in the adherence rate was observed.
气道正压通气（PAP）治疗是阻塞性睡眠呼吸暂停低通气综合征（OSAS）的标准治疗方法。
本研究旨在确定PAP的长期实际依从性及其预测因素。
在一项回顾性单中心观察性队列研究中，我们分析了2001年11月至2011年11月期间转诊至本中心的所有疑似OSAS患者。分析了每位患者的基线结果和末次随访数据。采用Kaplan-Meier法估计依从性，并对年龄、性别、爱泼华嗜睡量表（ESS）评分、体重指数、呼吸暂停低通气指数（AHI）和氧饱和度下降指数（ODI）进行Cox比例风险回归分析。通过比较每年队列中6个月和12个月内停用PAP的患者比例，分析依从性的变化情况。
在4638例转诊患者中，2187例确诊OSAS患者开始接受PAP治疗，297例（14%）转诊至其他中心进行随访，42例（2%）死亡，92例（5%）不再需要PAP治疗。在1756例患者中，中位随访时间为36个月[95%置信区间（CI）33.6 - 37.8]，1年、5年和10年的依从率分别为74%（CI：71 - 75；n = 1028）、55%（CI：53 - 58；n = 281）和51%（CI：48 - 55；n = 10）。依从性与ESS评分[风险比（HR）0.60；CI：0.47 - 0.78]、ODI（HR 0.50；CI：0.32 - 0.77）和AHI（HR 0.56；CI：0.37 - 0.85）相关。根据纳入日期的年度队列分析，前8年6个月和12个月的失访率分别为20%（CI：18 - 22）和27%（CI：25 - 30），后2年分别降至10%（CI：7 - 15）和14%（CI：10 - 19）。
OSAS患者对PAP的长期依从性与疾病严重程度的基线指标相关。2009年后，观察到依从率有所提高。
