Graco Marnie, Green Sally E, Tolson Julie, Stevens Bronwyn, Barnes Maree, Rigoni Alyssa, Henderson Sandra, Nicholls Carmel, Berlowitz David J
Institute for Breathing and Sleep, Austin Health, Melbourne, Victoria, Australia.
The University of Melbourne, Department of Medicine, Melbourne, Victoria, Australia.
Spinal Cord. 2019 Mar;57(3):247-254. doi: 10.1038/s41393-018-0210-z. Epub 2018 Oct 24.
Mixed methods OBJECTIVES: Continuous positive airway pressure (CPAP) therapy is the recommended treatment for obstructive sleep apnoea (OSA). The aim of this study was to estimate CPAP adherence in people with tetraplegia and OSA, and to explore the barriers and facilitators to CPAP use.
Hospital outpatient department in Melbourne, Australia METHODS: People with chronic tetraplegia and OSA were commenced with auto-titrating CPAP and supported for 1 month. Semi-structured interviews were conducted with participants at one month and analysed thematically. CPAP usage was measured at 1, 6 and 12 months, with "adherent" defined as achieving more than 4 h average per night.
Sixteen participants completed the study (80% male; mean age 56 (SD = 15)). Mean nightly CPAP use at one month was 3.1 h (SD = 2.5; 38% adherent), and at 6 months and 12 months were 2.6 h (SD = 2.8; 25% adherent) and 2.1 h (SD = 3.2; 25% adherent). The perceived benefit/burden balance strongly influenced ongoing use. Burden attributed to CPAP use was common, and included mask discomfort, and physical and emotional problems. Adherent participants were motivated by the immediate daytime benefits to mood, alertness and sleepiness. There was a tendency to not recognise symptoms of OSA until after they were treated.
CPAP use is challenging for people with tetraplegia, who experience substantial burden from using the device. When tolerated, the proximate benefits are substantial. People with tetraplegia need more intensive support for longer to help them overcome the burdens of CPAP and benefit from the treatment.
混合方法
持续气道正压通气（CPAP）疗法是阻塞性睡眠呼吸暂停（OSA）的推荐治疗方法。本研究的目的是评估四肢瘫痪合并OSA患者的CPAP依从性，并探讨CPAP使用的障碍和促进因素。
澳大利亚墨尔本的医院门诊部
慢性四肢瘫痪合并OSA的患者开始使用自动调压CPAP，并给予1个月的支持。在1个月时对参与者进行半结构化访谈，并进行主题分析。在1、6和12个月时测量CPAP使用情况，“依从”定义为每晚平均使用超过4小时。
16名参与者完成了研究（80%为男性；平均年龄56岁（标准差=15））。1个月时平均每晚CPAP使用时间为3.1小时（标准差=2.5；38%依从），6个月和12个月时分别为2.6小时（标准差=2.8；25%依从）和2.1小时（标准差=3.2；25%依从）。感知到的益处/负担平衡强烈影响持续使用。使用CPAP带来的负担很常见，包括面罩不适以及身体和情绪问题。依从的参与者受到白天情绪、警觉性和嗜睡方面即时益处的激励。在接受治疗之前，往往没有意识到OSA的症状。
对于四肢瘫痪患者来说，使用CPAP具有挑战性，他们在使用该设备时会承受很大负担。当能够耐受时，直接益处是显著的。四肢瘫痪患者需要更长时间的强化支持，以帮助他们克服CPAP的负担并从治疗中受益。
