阻塞性睡眠呼吸暂停合并急性冠状动脉综合征患者长期坚持持续气道正压通气治疗的预测因素
Predictors of long-term adherence to continuous positive airway pressure in patients with obstructive sleep apnoea and acute coronary syndrome.
作者信息
Florés Marina, Martinez-Alonso Montserrat, Sánchezde-la-Torre Alicia, Aldomà Albina, Galera Estefania, Barbé Ferran, Sánchezde-la-Torre Manuel, Dalmases Mireia
机构信息
Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova and Santa Maria, IRB Lleida, Lleida, Spain.
Unit of Biostatistics, IRB Lleida, Lleida, Spain.
出版信息
J Thorac Dis. 2018 Jan;10(Suppl 1):S124-S134. doi: 10.21037/jtd.2017.12.128.
BACKGROUND
Continuous positive airway pressure (CPAP) is an effective treatment for obstructive sleep apnoea (OSA), but an evaluation of CPAP adherence is rarely carried out among patients with acute coronary syndrome (ACS). The goals of the study are to analyse long-term adherence and identify the predictors of non-compliance with CPAP treatment for patients with non-sleepy OSA and ACS.
METHODS
This is an ancillary study of the ISAACC study, which is a multicentre, prospective, open-label, parallel, randomized, and controlled trial (NCT01335087) in patients with hospital admission for ACS. For the purpose of this study, only non-sleepy patients with moderate or severe OSA and randomized to receive CPAP treatment were analysed (n=357). Non-compliance was defined as CPAP dropout or average cumulative CPAP use of <4 hours/night. Multivariable logistic regression analysis was performed to identify predictors of CPAP adherence.
RESULTS
Adherence to treatment was 35.3% at 12 months. According to the unadjusted analysis, higher apnoea-hypopnea index (AHI) (P<0.001) and oxygen desaturation index (ODI) (P=0.001) were associated with a lower risk of non-compliance. Multivariable logistic regression analysis showed that high AHI (P=0.0051), high amounts of smoking pack-year (P=0.0170), and long intensive care unit (ICU) stays (P=0.0263) were associated with lower odds of non-compliance. It also showed a significant interaction between ACS history and age (P=0.0131), such that young patients with their first ACS showed significantly lower odds of CPAP non-compliance than patients with recurrent ACS and significantly lower odds of CPAP non-compliance were associated with ageing only in patients with recurrent ACS.
CONCLUSIONS
Protective factors against non-compliance with CPAP treatment in non-sleepy patients with ACS were illness severity (high values of AHI or ICU stay length) or smoking amount. Patients with no previous history of ACS showed lower odds of CPAP non-compliance than patients with a recurrent ACS with younger age.
背景
持续气道正压通气（CPAP）是治疗阻塞性睡眠呼吸暂停（OSA）的有效方法，但急性冠状动脉综合征（ACS）患者中很少对CPAP依从性进行评估。本研究的目的是分析非嗜睡OSA合并ACS患者长期使用CPAP的依从性，并确定不依从CPAP治疗的预测因素。
方法
这是ISAACC研究的一项辅助研究，ISAACC研究是一项针对因ACS住院患者的多中心、前瞻性、开放标签、平行、随机对照试验（NCT01335087）。本研究仅分析了中度或重度OSA且随机接受CPAP治疗的非嗜睡患者（n = 357）。不依从定义为停用CPAP或平均每晚累计使用CPAP时间<4小时。采用多变量逻辑回归分析确定CPAP依从性的预测因素。
结果
12个月时治疗依从率为35.3%。未经校正的分析显示，较高的呼吸暂停低通气指数（AHI）（P<0.001）和氧饱和度下降指数（ODI）（P = 0.001）与较低的不依从风险相关。多变量逻辑回归分析表明，高AHI（P = 0.0051）、大量吸烟包年数（P = 0.0170）和较长的重症监护病房（ICU）住院时间（P = 0.0263）与较低的不依从几率相关。分析还显示ACS病史与年龄之间存在显著交互作用（P = 0.0131），即首次发生ACS的年轻患者CPAP不依从几率显著低于复发性ACS患者，且仅在复发性ACS患者中，CPAP不依从几率随年龄增长而显著降低。
结论
非嗜睡ACS患者中，防止不依从CPAP治疗的保护因素为疾病严重程度（高AHI值或ICU住院时间）或吸烟量。无ACS病史的患者CPAP不依从几率低于复发性ACS的年轻患者。
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