Budhiraja Rohit, Kushida Clete A, Nichols Deborah A, Walsh James K, Simon Richard D, Gottlieb Daniel J, Quan Stuart F
Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Division of Sleep Medicine, Harvard Medical School, Boston, MA.
Stanford University Sleep Clinic and Center for Human Sleep Research, Redwood City, CA.
J Clin Sleep Med. 2016 Mar;12(3):333-41. doi: 10.5664/jcsm.5578.
To evaluate factors associated with continuous positive airway pressure (CPAP) adherence in patients with obstructive sleep apnea (OSA) in the Apnea Positive Pressure Long-term Efficacy Study (APPLES) cohort.
The data from a prospective 6-mo multicenter randomized controlled trial with 558 subjects randomized to active CPAP and 547 to sham CPAP were analyzed to assess adherence to CPAP during first 2 mo (early period) and during months 5-6 (late period).
Participants randomized to active CPAP had higher hours of nightly adherence compared to the sham CPAP group at both 2 (4.9 ± 2.0 h versus 4.07 ± 2.14 h, p < 0.001) and 6 mo (4.70 ± 2.08 h versus 3.41 ± 2.19 h, p < 0.001). Those assigned to sham CPAP were more likely to correctly identify their treatment group (70.0% versus 55.2%, p < 0.001). Irrespective of treatment group assignment, those who believed they were receiving active CPAP had higher hours of adherence than those who thought they were in the sham CPAP group at both 2 mo (4.91 ± 2.01 versus 4.17 ± 2.17, p < 0.001) and 6 mo (4.65 ± 2.10 versus 3.65 ± 2.22, p < 0.001). Among those randomized to active CPAP, older age was significantly related to CPAP use > 4 h per night. Presence of cardiovascular disorders was associated with higher hours of CPAP use, whereas presence of anxiety was associated with a trend toward lower hours of CPAP use. Presence of nasal congestion was associated with a decrease in mean daily CPAP use between the early and the late adherence period. The adherence during the week prior to a clinic visit was higher than the average adherence during the 2-mo period prior to the visit.
Randomization to active therapy, belief that one is in the active treatment group, older age, and possibly presence of cardiovascular disorders are positively linked to CPAP adherence. Nasal congestion and anxiety are negatively associated with CPAP adherence. CPAP nightly usage increases as clinic visits approach.
在睡眠呼吸暂停正压通气长期疗效研究（APPLES）队列中，评估与阻塞性睡眠呼吸暂停（OSA）患者持续气道正压通气（CPAP）依从性相关的因素。
对一项为期6个月的前瞻性多中心随机对照试验的数据进行分析，该试验将558名受试者随机分为主动CPAP组和547名分为假CPAP组，以评估前2个月（早期）和第5 - 6个月（晚期）期间对CPAP的依从性。
随机分配到主动CPAP组的参与者在2个月（4.9±2.0小时对4.07±2.14小时，p<0.001）和6个月（4.70±2.08小时对3.41±2.19小时，p<0.001）时，每晚的依从小时数均高于假CPAP组。分配到假CPAP组的参与者更有可能正确识别自己的治疗组（70.0%对55.2%，p<0.001）。无论治疗组分配如何，那些认为自己接受主动CPAP治疗的参与者在2个月（4.91±2.01对4.17±2.17，p<0.001）和6个月（4.65±2.10对3.65±2.22，p<0.001）时的依从小时数均高于那些认为自己在假CPAP组的参与者。在随机分配到主动CPAP组的参与者中，年龄较大与每晚使用CPAP>4小时显著相关。心血管疾病的存在与CPAP使用时间较长有关，而焦虑的存在与CPAP使用时间呈降低趋势有关。鼻塞的存在与早期和晚期依从期之间平均每日CPAP使用量的减少有关。就诊前一周的依从性高于就诊前2个月期间的平均依从性。
随机分配到主动治疗、认为自己在主动治疗组、年龄较大以及可能存在心血管疾病与CPAP依从性呈正相关。鼻塞和焦虑与CPAP依从性呈负相关。随着就诊时间的临近，每晚CPAP使用量增加。
