Balakrishnan Karthik, James Kathryn T, Weaver Edward M
Department of Otorhinolaryngology - Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, MN.
Department of Otolaryngology - Head & Neck Surgery, University of Washington, Seattle, WA.
J Clin Sleep Med. 2016 Jun 15;12(6):849-54. doi: 10.5664/jcsm.5884.
Measures of baseline sleep apnea disease burden (apnea-hypopnea index, Epworth Sleepiness Scale) predict continuous positive airway pressure (CPAP) adherence, but composite indices of sleep apnea severity (Sleep Apnea Severity Index, Modified Sleep Apnea Severity Index) may be more robust measures of disease burden. We tested the relative prognostic ability of each measure of sleep apnea disease burden to predict subsequent CPAP adherence and subjective sleep outcomes.
Prospective cohort study at a tertiary academic sleep center. Patients (n = 323) underwent initial diagnostic polysomnography for suspected obstructive sleep apnea and 6 mo of subsequent CPAP therapy.
Baseline apnea-hypopnea index and both composite indices predicted adherence to CPAP therapy at 6 mo in multivariate analyses (all p ≤ 0.001). Baseline Epworth Sleepiness Scale did not predict CPAP adherence (p = 0.22). Both composite indices were statistically stronger predictors of CPAP adherence at 6 mo than apnea-hypopnea index (p < 0.001). In multivariate analyses, baseline apnea-hypopnea index (p < 0.05) and both composite indices (both p < 0.04) predicted change in Pittsburgh Sleep Quality Index, whereas only the composite indices predicted changes in Sleep Apnea Quality of Life Index (both p < 0.001). Adjustment for treatment adherence did not affect the relationship of the composite indices with change in Sleep Apnea Quality of Life Index (both p ≤ 0.005).
Composite indices of baseline sleep apnea severity better predict objective CPAP adherence and subjective treatment outcomes than baseline apnea-hypopnea index and baseline Epworth Sleepiness Scale.
基线睡眠呼吸暂停疾病负担指标（呼吸暂停低通气指数、爱泼沃斯思睡量表）可预测持续气道正压通气（CPAP）治疗的依从性，但睡眠呼吸暂停严重程度的综合指数（睡眠呼吸暂停严重程度指数、改良睡眠呼吸暂停严重程度指数）可能是更可靠的疾病负担指标。我们测试了每种睡眠呼吸暂停疾病负担指标预测后续CPAP治疗依从性和主观睡眠结局的相对预后能力。
在一家三级学术睡眠中心进行前瞻性队列研究。患者（n = 323）因疑似阻塞性睡眠呼吸暂停接受了初始诊断性多导睡眠图检查，并接受了6个月的后续CPAP治疗。
在多变量分析中，基线呼吸暂停低通气指数和两个综合指数均预测了6个月时对CPAP治疗的依从性（所有p≤0.001）。基线爱泼沃斯思睡量表不能预测CPAP治疗的依从性（p = 0.22）。两个综合指数在统计学上都是比呼吸暂停低通气指数更强的6个月时CPAP治疗依从性预测指标（p < 0.001）。在多变量分析中，基线呼吸暂停低通气指数（p < 0.05）和两个综合指数（均p < 0.04）预测了匹兹堡睡眠质量指数的变化，而只有综合指数预测了睡眠呼吸暂停生活质量指数的变化（均p < 0.001）。对治疗依从性进行调整并不影响综合指数与睡眠呼吸暂停生活质量指数变化之间的关系（均p≤0.005）。
与基线呼吸暂停低通气指数和基线爱泼沃斯思睡量表相比，基线睡眠呼吸暂停严重程度的综合指数能更好地预测客观CPAP治疗依从性和主观治疗结局。
