Sleep and Ventilation Center Blaubeuren, Lung Center Ulm, Ulm, Germany.
Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Germany.
Sleep Med. 2018 Jan;41:20-26. doi: 10.1016/j.sleep.2017.07.026. Epub 2017 Sep 9.
OBJECTIVE/BACKGROUND: This study investigated the addition of a real-time feedback patient engagement tool on positive airway pressure (PAP) adherence when added to a proactive telemedicine strategy.
PATIENTS/METHODS: Data from a German healthcare provider (ResMed Healthcare Germany) were retrospectively analyzed. Patients who first started PAP therapy between 1 September 2009 and 30 April 2014, and were managed using telemedicine (AirView™; proactive care) or telemedicine + patient engagement tool (AirView™ + myAir™; patient engagement) were eligible. Patient demographics, therapy start date, sleep-disordered breathing indices, device usage hours, and therapy termination rate were obtained and compared between the two groups.
The first 500 patients managed by telemedicine-guided care and a patient engagement tool were matched with 500 patients managed by telemedicine-guided care only. The proportion of nights with device usage ≥4 h was 77 ± 25% in the patient engagement group versus 63 ± 32% in the proactive care group (p < 0.001). Therapy termination occurred less often in the patient engagement group (p < 0.001). The apnea-hypopnea index was similar in the two groups, but leak was significantly lower in the patient engagement versus proactive care group (2.7 ± 4.0 vs 4.1 ± 5.3 L/min; p < 0.001).
Addition of a patient engagement tool to telemonitoring-guided proactive care was associated with higher device usage and lower leak. This suggests that addition of an engagement tool may help improve PAP therapy adherence and reduce mask leak.
目的/背景：本研究旨在探讨在主动远程医疗策略中添加实时反馈式患者参与工具对正压通气（PAP）依从性的影响。
患者/方法：对德国医疗保健提供商（ResMed Healthcare Germany）的数据进行回顾性分析。符合条件的患者于 2009 年 9 月 1 日至 2014 年 4 月 30 日首次开始 PAP 治疗，采用远程医疗（AirView™；主动护理）或远程医疗+患者参与工具（AirView™+myAir™；患者参与）进行管理。获取并比较两组患者的人口统计学特征、治疗开始日期、睡眠呼吸紊乱指数、设备使用时间和治疗终止率。
匹配了 500 例采用远程医疗指导护理和患者参与工具管理的患者与 500 例仅采用远程医疗指导护理管理的患者。在患者参与组中，设备使用时间≥4 小时的夜间比例为 77±25%，而在主动护理组中为 63±32%（p<0.001）。患者参与组的治疗终止发生率较低（p<0.001）。两组的呼吸暂停低通气指数相似，但患者参与组的漏气明显低于主动护理组（2.7±4.0 与 4.1±5.3 L/min；p<0.001）。
在远程监测指导的主动护理中添加患者参与工具与设备使用率提高和漏气减少相关。这表明，添加参与工具可能有助于提高 PAP 治疗依从性并减少面罩漏气。
