Tan Bernard, Tan Alvin, Chan Yiong Huak, Mok Yingjuan, Wong Hang Siang, Hsu Pon Poh
Department of Otolaryngology-Head and Neck Surgery, Changi General Hospital, Singapore.
Department of Otolaryngology-Head and Neck Surgery, Changi General Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Am J Otolaryngol. 2018 Sep-Oct;39(5):501-506. doi: 10.1016/j.amjoto.2018.05.012. Epub 2018 May 26.
To investigate the rates of Continuous Positive Airway Pressure (CPAP) uptake and adherence amongst Singaporean patients diagnosed with Obstructive Sleep Apnea (OSA), and to evaluate factors correlated with CPAP uptake and adherence.
Retrospective review of medical records.
Medical records were reviewed for baseline demographics, daytime sleepiness, presence of nasal symptoms and OSA severity, initial treatment choice, the rate of CPAP treatment uptake and CPAP adherence at 1 and 12 months.
2160 patients were diagnosed with OSA within the 5-year period (2011-2015). 463 (21.4%) had mild OSA, 583 (27.0%) had moderate OSA and 1114 (51.6%) had severe OSA. For initial therapy, 751 (34.8%) patients opted for a 1-month CPAP trial, 288 (13.3%) patients chose surgery upfront, 291 (13.5%) patients chose adjunctive treatments (weight loss, positional therapy, dental appliance, intranasal steroid spray for allergic rhinitis) and 830 (38.4%) patients rejected all forms of treatment. 337 out of 751 patients (44.9%) were adherent to CPAP therapy during the 1 month trial. 381 out of 751 (50.7%) patients took up CPAP therapy following the trial period, of which 299 out of 381 (78.5%) patients were adherent to CPAP therapy at 1 year. CPAP adherence during the 1-month trial was a predictor for eventual CPAP treatment uptake and CPAP adherence at 1 year (p < 0.001). Age (p < 0.001), BMI (p < 0.001) and normal ESS (p = 0.01) were predictors of treatment rejection. 24 patients underwent upper airway surgery during their first year of using CPAP. 21 out of the 24 patients (87.5%) were adherent to CPAP at 1 year after undergoing surgery. These patients had a higher rate of CPAP adherence compared to the overall cohort (87.5% versus 78.5%), but this was not statistically significant (p > 0.05).
Singaporean patients who accept CPAP therapy after an initial 1-month CPAP trial will generally be adherent to CPAP therapy. Initial patterns of CPAP usage are predictive of long term CPAP adherence. However, there is a high rate of CPAP treatment rejection both at the time of diagnosis and after the CPAP trial. Upper airway surgery in selected patients may improve CPAP adherence.
调查新加坡阻塞性睡眠呼吸暂停（OSA）患者持续气道正压通气（CPAP）的使用和依从率，并评估与CPAP使用和依从性相关的因素。
病历回顾性研究。
回顾病历以获取基线人口统计学资料、日间嗜睡情况、鼻部症状及OSA严重程度、初始治疗选择、CPAP治疗使用率以及1个月和12个月时的CPAP依从性。
在5年期间（2011 - 2015年），2160例患者被诊断为OSA。463例（21.4%）为轻度OSA，583例（27.0%）为中度OSA，1114例（51.6%）为重度OSA。对于初始治疗，751例（34.8%）患者选择进行1个月的CPAP试验，288例（13.3%）患者直接选择手术，291例（13.5%）患者选择辅助治疗（减肥、体位治疗、口腔矫治器、用于过敏性鼻炎的鼻内类固醇喷雾剂），830例（38.4%）患者拒绝所有形式的治疗。751例患者中有337例（44.9%）在1个月试验期间坚持CPAP治疗。751例患者中有381例（50.7%）在试验期后接受了CPAP治疗，其中381例中的299例（78.5%）患者在1年时坚持CPAP治疗。1个月试验期间的CPAP依从性是最终CPAP治疗使用率和1年时CPAP依从性的预测指标（p < 0.001）。年龄（p < 0.001）、体重指数（BMI）（p < 0.001）和正常的Epworth嗜睡量表（ESS）评分（p = 0.01）是治疗拒绝的预测指标。24例患者在使用CPAP的第一年接受了上气道手术。24例患者中有21例（87.5%）在手术后1年坚持使用CPAP。与总体队列相比，这些患者的CPAP依从率更高（87.5%对78.5%），但差异无统计学意义（p > 0.05）。
在最初1个月的CPAP试验后接受CPAP治疗的新加坡患者通常会坚持CPAP治疗。CPAP的初始使用模式可预测长期CPAP依从性。然而，在诊断时和CPAP试验后，CPAP治疗拒绝率较高。对选定患者进行上气道手术可能会提高CPAP依从性。
