Chen Yung-Fu, Hang Liang-Wen, Huang Chun-Sen, Liang Shinn-Jye, Chung Wei-Sheng
Department of Healthcare Administration, Central Taiwan University of Science and Technology, Taichung, Taiwan.
Sleep Medicine Center, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.
Kaohsiung J Med Sci. 2015 Feb;31(2):83-9. doi: 10.1016/j.kjms.2014.11.004. Epub 2014 Dec 18.
Extensive use of continuous positive airway pressure (CPAP) has positive clinical benefits for most patients with obstructive sleep apnea (OSA). However, patient adherence is a major limiting factor to the effectiveness of CPAP treatment. This study determined the potential and quantifiable factors affecting the willingness of patients with OSA to undertake CPAP treatment by comparing the polysomnographic parameters recorded during diagnosis and titration. Patients with moderate and severe OSA who attended diagnostic polysomnography (PSG) and CPAP titration at the sleep center of China Medical University Hospital (CMUH) were included in the study. A total of 312 patients were divided into persistent users and nonusers of CPAP according to their use of in-home CPAP following titration and a 7-day CPAP trial. Multivariate logistic regression analyses were used to define the potential polysomnographic predictors of persistent CPAP adherence, and odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Most patients were men older than 50 years who were overweight or obese. Among the patients, 146 (46.8%) became persistent CPAP users. A 10% improvement of oxygen desaturation index (ODI) and a 10% increment in deep sleep percentage increased the chance of persistent CPAP use 1.18-fold and 1.07-fold, respectively. In addition, the improved ODI and deep sleep during CPAP titration increased the chance of persistent CPAP user. The polysomnographic parameters obtained from diagnosis and during titration can facilitate the prediction of persistent CPAP use.
对于大多数阻塞性睡眠呼吸暂停（OSA）患者而言，广泛使用持续气道正压通气（CPAP）具有积极的临床益处。然而，患者的依从性是CPAP治疗效果的主要限制因素。本研究通过比较诊断和滴定过程中记录的多导睡眠图参数，确定了影响OSA患者接受CPAP治疗意愿的潜在且可量化的因素。纳入在中国医科大学附设医院（CMUH）睡眠中心接受诊断性多导睡眠图（PSG）检查和CPAP滴定的中度和重度OSA患者。根据滴定后在家中使用CPAP的情况以及7天的CPAP试验，将总共312例患者分为CPAP持续使用者和非使用者。采用多变量逻辑回归分析来确定持续CPAP依从性的潜在多导睡眠图预测因素，并计算优势比（OR）和95%置信区间（CI）。大多数患者为50岁以上的超重或肥胖男性。在这些患者中，146例（46.8%）成为CPAP持续使用者。氧去饱和指数（ODI）改善10%和深睡眠百分比增加10%，分别使持续使用CPAP的几率增加1.18倍和1.07倍。此外，CPAP滴定期间ODI和深睡眠的改善增加了成为CPAP持续使用者的几率。从诊断和滴定过程中获得的多导睡眠图参数有助于预测CPAP的持续使用情况。
