Section of Pulmonary and Critical Care, Sleep Disorders Center, Department of Medicine, University of Chicago, Chicago, Illinois, USA.
Section of Hospital Medicine, Department of Medicine, University of Chicago, Chicago, Illinois, USA.
Thorax. 2017 Dec;72(12):1132-1139. doi: 10.1136/thoraxjnl-2017-210106. Epub 2017 Jun 30.
Suboptimal adherence to CPAP limits its clinical effectiveness in patients with obstructive sleep apnoea (OSA). Although rigorous behavioural interventions improve CPAP adherence, their labour-intensive nature has limited widespread implementation. Moreover, these interventions have not been tested in patients at risk of poor CPAP adherence. Our objective was to determine whether an educational video will improve CPAP adherence in patients at risk of poor CPAP adherence.
Patients referred by clinicians without sleep medicine expertise to an urban sleep laboratory that serves predominantly minority population were randomised to view an educational video about OSA and CPAP therapy before the polysomnogram, or to usual care. The primary outcome was CPAP adherence during the first 30 days of therapy. Secondary outcomes were show rates to sleep clinic (attended appointment) and 30-day CPAP adherence after the sleep clinic visit date.
A total of 212 patients met the eligibility criteria and were randomised to video education (n=99) or to usual care (n=113). There were no differences in CPAP adherence at 30 days (3.3, 95% CI 2.8 to 3.8 hours/day video education; vs 3.5, 95% CI 3.1 to 4.0 hours/day usual care; p=0.44) or during the 30 days after sleep clinic visit. Sleep clinic show rate was 54% in the video education group and 59% in the usual care group (p=0.41). CPAP adherence, however, significantly worsened in patients who did not show up to the sleep clinic.
In patients at risk for poor CPAP adherence, an educational video did not improve CPAP adherence or show rates to sleep clinic compared with usual care.
ClinicalTrials.gov Identifier: NCT02553694.
阻塞性睡眠呼吸暂停（OSA）患者 CPAP 治疗依从性欠佳会限制其临床疗效。尽管严格的行为干预措施可提高 CPAP 治疗依从性，但由于其劳动强度大，限制了其广泛应用。此外，这些干预措施尚未在 CPAP 治疗依从性差风险患者中进行测试。本研究旨在确定教育视频是否会提高 CPAP 治疗依从性差风险患者的 CPAP 治疗依从性。
本研究将临床医生转诊至未具备睡眠医学专业知识的城市睡眠实验室的患者随机分为两组，一组在进行多导睡眠图检查前观看关于 OSA 和 CPAP 治疗的教育视频，另一组采用常规护理。主要结局是治疗的前 30 天内 CPAP 治疗依从性。次要结局是睡眠诊所就诊率（出席预约）和睡眠诊所就诊日期后 30 天 CPAP 治疗依从性。
共有 212 名符合入选标准的患者被随机分为视频教育组（n=99）或常规护理组（n=113）。30 天 CPAP 治疗依从性（视频教育组 3.3 小时/天，95%CI 2.8 至 3.8 小时/天；常规护理组 3.5 小时/天，95%CI 3.1 至 4.0 小时/天；p=0.44）或睡眠诊所就诊日期后 30 天 CPAP 治疗依从性均无差异。视频教育组睡眠诊所就诊率为 54%，常规护理组为 59%（p=0.41）。然而，未到睡眠诊所就诊的患者 CPAP 治疗依从性显著恶化。
在 CPAP 治疗依从性差风险患者中，与常规护理相比，教育视频并未提高 CPAP 治疗依从性或睡眠诊所就诊率。
ClinicalTrials.gov 标识符：NCT02553694。
